4/4/2023 0 Comments Csf fluid image![]() 220,269 The difficulty in isolation of EVs from CSF may also relate to the low titers of EV in CSF (as low as a median tissue culture infective dose of 10 to 10 3/mL of CSF) and that no single cell line is optimal for the detection of all members of the genus. A specific virologic diagnosis of enteroviral meningitis depends on isolation of the virus from the CSF in tissue culture, 269 although the sensitivity for enteroviral serotypes is only 65% to 75%, largely a result of the inability to grow many coxsackievirus A serotypes, which require suckling mouse inoculations. Elevated CSF protein and decreased CSF glucose concentrations, if present, are usually mild, although extreme degrees of both have been reported. 267 This was also observed in another study of 60 patients, 23 of whom had no CSF pleocytosis 268 those who lacked CSF pleocytosis were younger, had experienced more drowsiness, had lower peripheral WBC counts, and had a higher serum CRP concentration. In addition, in one study of 65 infants younger than 3 months of age with enteroviral meningitis, 60% had no CSF pleocytosis. 261 However, in a recent retrospective chart review of 158 cases of meningitis (138 aseptic and 20 bacterial), 51% of the 53 patients with aseptic meningitis and duration of symptoms of more than 24 hours had a neutrophil predominance in CSF, 266 suggesting that a CSF neutrophil predominance is not useful as a sole criterion in distinguishing between aseptic and bacterial meningitis. 261 If a repeat lumbar puncture is done more than 8 hours later, the CSF WBC differential may change to a lymphocytic pleocytosis, 265 but this practice is done currently in only 0.5% of patients with a viral CNS infections. 220 EV can manifest with a neutrophilic pleocytosis in 39% of patients. 260 The cell count is usually 100 to 1000/mm, 3 although counts in the several thousands have also been reported. 220,260 A study of 390 patients with enteroviral meningitis showed that 16% to 18% of children and 68% to 77% of neonates had no CSF pleocytosis younger age, lower serum WBC counts, and shorter duration of symptoms prior to the lumbar puncture were predictors for lack of CSF pleocytosis. ![]() Bennett MD, in Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 2020 Cerebrospinal Fluid ExaminationĬSF pleocytosis is almost always present in patients with enteroviral meningitis, although some EVs have been isolated from young infants with clinical evidence of meningitis but no CSF WBCs. Low glucose protein mildly elevated complement-fixing antibodies in CSF antigen detectable in CSF, urine, serum Low glucose, protein elevated, antigen detection possible in CSF and urine Low glucose, elevated protein, presence of complement-fixing antibody Low glucose, elevated protein, polymerase chain reaction positive for M. Low glucose, protein may be markedly elevated Low glucose, elevated protein, enzyme immunoassay or enzyme-linked immunosorbent assay for Aspergillus galactomannan Low glucose, elevated protein, culture positive ![]() Low glucose, elevated protein, anaerobic culture positive Low glucose, markedly elevated protein, culture positive ![]()
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