In the name of Allah

ROLE OF CEREBROSPINAL FLUID IN THE DIAGNOSIS OF

MENINGITIS

IHSAN ALITRAINEE TECHNOLOGIST

AKUH

What is meningitis?……

The brain and spinal cord are covered by connective tissue layers collectively called the meninges which form the blood-brain barrier.

1-the pia mater (closest to the CNS)

2-the arachnoid mater

3-the dura mater (farthest from the CNS).

The meninges contain cerebrospinal fluid (CSF).

Meningitis is an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain .

What is Meningitis?

Meningitis can be caused by many different organisms including viruses and bacteria. Meningitis, caused by a bacteria, is life threatening and requires urgent medical attention and treatment with antibiotics. Meningitis caused by a virus is very rarely life threatening but can cause the body to become very weak. When bacteria invade the body they can cause meningitis, septicaemia or meningitis and septicaemia together

Causes of Meningitis

-Bacterial Infections-Viral Infections

-Fungal Infections(Cryptococcus neoformans

Coccidiodes immitus)

Bacterial meningitis…..Etiological Agents:

Pneumococcal, Streptococcus pneumoniae (38%)

Meningococcal, Neisseria meningitidis (14%)

Haemophilus influenzae (4%)

Staphylococcal, Staphylococcus aureus (5%)

Tuberculous, Mycobacterium tuberculosis

Viral Meningitis

Etiological Agents:

Enteroviruses (Coxsackie's and echovirus): most common .

-Adenovirus

-Arbovirus

-Measles virus

-Herpes Simplex Virus

-Varicella

Symptoms of Meningitis

Meningitis may not always be easy to detect, in early stages the symptoms can be similar to flu.  They may develop over one or two days, but sometimes develop in a matter of hours.

It is important to remember that symptoms do not appear in any particular order and some may not appear at all.

Symptoms for meningitis:

:Babies and Young Children-High temperature, fever, possibly with cold hands and

feet-Vomiting or refusing feeds

-Whimpering cry-Blank, staring expression-Pale, blotchy complexion

-Stiff neck-Arched back

-Difficult to wake or lethargic-The fontanelle (soft spot on babies heads) may be

tense or bulging.

Older Children and Adults

-High temperature, fever, possibly with cold hands and feet.

-Vomiting, sometimes diarrhoea.-Severe headache.

-Joint or muscle pains, sometimes stomach cramps.-Neck stiffness (unable to touch the chin to the chest)

-Dislike of bright lights.-Drowsiness.

The patient may be confused or disorientated. Fitting may also be seen.A rash may develop.

LUMBER PUNCTURE

LUMBER PUNCTURE:

CSF NORMAL COMPOSITION AND PRESSURE

Normal opening pressure in adults is 90~180mmH2O, 10~100mmH2O in children.

Colour less<5 RBCs<5 WBCs

Protein 23-38 mg/dlGlucose 60% of serum level(50-80)

Elevated pressure

Acute Purulent MeningitisTuberculous MeningitisViral MenigitisCerebral edemaMass lesion

Glucose

The normal Glucose is about 60% compared to serum level.Normal 50~80mg/dlViral meningitis < 50% of serum levelDecreased GlucoseBacterial Meningitis(very low)

Protein

Over 80% of CSF protein content is derived from the plasma.

An increased CSF protein serves as a useful but nonspecific indicator of disease.Normal level 23~38mg/dl.

Elevated in all infectious meningitisMay remains elevated for months post meningitis (Viral or Bacterial)

White Blood cells count

Total WBC,s CountPrepare 1:2 Dilution with Turk solutionCharge on Neubeur Chamber

Count in 4 large (WBC,s)squaresDifferential WBC,s CountCentrifuge CSFPrepare slide from DepositStain with Leishman stain

White Blood cells in CSF

<5 White Blood cells Increased in Bacterial Meningitis (Neutrophills)Increased in Viral Meningitis (lymphocytes)Increased in Tuberculosis Meningitis (Neutrophills , Lymphocytes)

Culture of CSF

CSF Contains few organisms so concentration is requiredCentrifuge at 10000rpm for 10 minsSediments is used for culturesMedia Used

Chocolate AgarMacconkey AgarBlood Agar

LATEX PARTICAL AGGLUTINATION TEST (LPA)

ANTIGEN & ANTIBODY REACTION Keep CSF for 5 mins in boiling waterExposure of AntigenTreated with anti-seraAgglutination PositiveFor Bacteria.

Thank You