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Tuberculosis in Childhood and Pregnancy
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Lindsay H. Cameron, Jeffrey R. Starke
Confirming a diagnosis of tuberculous meningitis can be extremely difficult. The TST and IGRAs are negative in up to 50% of cases, and 20%–50% of children have a normal chest radiograph.76 The most important laboratory test for the diagnosis of tuberculous meningitis is examination and culture of the lumbar cerebrospinal fluid (CSF). The CSF leukocyte count usually ranges from 10 to 500 cells/μL. Polymorphonuclear leukocytes may be present initially and may portend a poorer prognosis, but a lymphocyte predominance is more typical. The CSF glucose is usually between 20 and 40 mg/dL, whereas the CSF protein level is elevated and may be markedly high (400–5,000 mg/dL). The success of the microscopic examination of stained CSF and mycobacterial cultures correlates with the volume of the CSF sample. When a minimum of 10 mL of lumbar CSF is available, the acid-fast stain of the CSF sediment is positive in up to 30% of cases and the culture is positive in up to 70% of cases. Unfortunately, a volume of 1–2 mL is usually all that can be obtained from a young child. Polymerase chain reaction (PCR) testing of the CSF can improve diagnosis. Cultures of other body fluids can help confirm the diagnosis.
Acute Bacterial Meningitis and Its Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Viral/aseptic meningitis is uniformly associated with a normal CSF glucose, with a few important exceptions. The presence of a normal CSF glucose in a patient with suspected ABM meningitis suggests a viral or non-infectious mimic of meningitis. Viruses capable of decreasing the CSF glucose include HSV, lymphocytic choriomeningitis (LCM), mumps, and occasionally enteroviruses. These exceptions aside, a normal CSF glucose virtually excludes a bacterial etiology of ABM [1,5,8,14,18,28,29].
Enteroviruses
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Karen Straube-West, Burk Jubelt
The CSF profile in viral meningitis usually consists of a mononuclear cell pleocytosis with a normal glucose. However, virus has been recovered from the CSF with normal leukocyte counts [37]. Occasionally during the first 24–48 hours of the infection, polymorphonuclear cells may be seen, mimicking bacterial meningitis. Rarely the CSF glucose may be low, as in fungal and tuberculous meningitis [6].
Optic neuropathy after COVID-19 vaccination: a report of two cases
Published in International Journal of Neuroscience, 2023
Ayman G. Elnahry, Zainab B. Asal, Noreen Shaikh, Kate Dennett, Mai N. Abd Elmohsen, Gehad A. Elnahry, Azza Shehab, Michal Vytopil, Leila Ghaffari, Geetha K. Athappilly, David J. Ramsey
Magnetic resonance imaging (MRI) of the brain and orbits was normal. MRI of cervical and thoracic spine was normal. Magnetic resonance venography (MRV) of the head was unremarkable. Cerebrospinal fluid (CSF) analysis demonstrated normal opening pressure (9 cm H2O) and lymphocytic pleocytosis with 26 white blood cells (94% lymphocytes) and <1 erythrocyte. CSF protein was mildly elevated at 49 mg/dL (normal 15–45 mg/dL) and CSF glucose was normal. The remainder of CSF studies was normal, including flow cytometry, protein electrophoresis, paraneoplastic antibodies, myelin basic protein, Venereal Disease Research Laboratory, Lyme antibodies, angiotensin-converting enzyme, IgG index, and PCR for herpes simplex virus, varicella zoster virus, cytomegalovirus, and Epstein-Barr virus. Serum studies revealed normal C-reactive protein (CRP), angiotensin converting enzyme (ACE) and were negative for antinuclear antibodies (ANA), anti-neutrophil cytoplasmic (ANCA), anti-proteinase 3, anti-myeloperoxidase, Aquaporin 4 (AQP4)-IgG, and IgG1 myelin oligo-glycoprotein (anti-MOG) antibodies. Serologies were negative for Lyme disease, Toxoplasmosis, rapid plasma reagin (RPR), human immunodeficiency virus, and Bartonella. Coronavirus-SARS-CoV-2 PCR was negative. A computed tomography of the chest, abdomen, and pelvis was unremarkable.
Breakthrough pneumonia, meningitis and bloodstream infection due to Streptococcus pneumoniae during cefixime therapy
Published in Journal of Chemotherapy, 2019
Novella Carannante, Carlo Pallotto, Mariano Bernardo, Enza Mallardo, Giovanni Di Caprio, Giulia Palmiero, Vittorio Attanasio, Carlo Tascini
A 13 year-old young male was admitted to our hospital for otitis, intense headache and fever, with the suspect of meningitis. The patient symptoms began 7 days before and he was treated at home with cefixime 400 mg per day for 5 days, without resolution of symptoms. The young boy presented meningeal syndrome. The CT of the right ear highlighted massive opacification of the right mastoid. The lumbar puncture revealed a purulent CSF with leukocytes count 28000/mm3, CSF glucose 41 mg/dl, blood glucose 123 mg/dl. The CSF culture was positive for S. pneumoniae with the following antibiogram: susceptibility to penicillin (MIC 0.012 mg/L) and to ceftriaxone (MIC 0.003 mg/L); MIC for cefixime was 0.064mg/L. The patient was treated successfully with ceftriaxone 2 g/day and rifampin 600 mg/day for 14 days. S. pneumoniae was characterized as serotype 3.
Neurobrucellosis
Published in International Journal of Neuroscience, 2018
Na Zheng, Wei Wang, Jia-Tang Zhang, Ya Cao, Long Shao, Jiao-Jiao Jiang, Xu-Sheng Huang, Cheng-Lin Tian, Sheng-Yuan Yu
In our study, 16 (94%) patients presented with increased leukocyte count, and 13 (76.5%) patients presented with increased protein levels. Fifteen (88.2%) patients had low glucose level, which is higher than the rates found in previous reports. Previous studies have reported that the CSF of NB patients indicated lymphatic pleistocene with increased protein levels in nearly all NB patients with low glucose levels in one-third [14]. This finding indicates that CSF glucose levels may be associated with disease severity. In our region, most patients with atypical and serious diseases, such as NB, are referred to our hospital, whereas uncomplicated cases are treated in their hometown. As this is a disease with an atypical presentation, clinicians often misdiagnose this disease which results in a lack of immediate and definitive treatment and can lead to acerbation. The severity and long course of NB may be the cause of the high rate of patients with low CSF glucose levels. In our study, serum STA and CSF STA were 88.2% and 59%, respectively, and our data supports the hypothesis that blood astrological tests are significantly more sensitive than CSF tests. Although bacterial culture is the reference standard for the diagnosis of infectious diseases, it has been demonstrated to be suboptimal for NB [15]. In our study, only two patients underwent specimen culture, and Brucella bacteria were isolated from their CSF and blood. Because culturing Brucella is time-consuming, diagnosis is usually based on indirect serological tests.