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Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
Laboratory diagnosis of meningitis
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Laboratory diagnosis of meningitis

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LABORATORY DIAGNOSIS OF MENINGITIS WITH IMAGES AND VIDEO OF LUMBAR PUNCTURE.

LABORATORY DIAGNOSIS OF MENINGITIS WITH IMAGES AND VIDEO OF LUMBAR PUNCTURE.

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  • 1. M. HARINI PRIYADHARSHINI II MBBS
  • 2. • These are among the most important problems in medicine today • Common acute infections of the nervous system include: Acute bacterial meningitis Viral meningitis Brain abscess Empyema Encephalitis • Each may present with a non-specific prodrome of fever and headache.
  • 3. • Inflammatory process of leptomeninges and CSF within the subarachnoid space. • Meningoencephalitis combines this with inflammation of brain parenchyma. • Meningitis is usually caused by a infection - Acute pyogenic (bacterial)or aseptic (viral) and Chronic(usually due to tuberculous, spirochetal or cryptococcal).
  • 4. ACUTE BACTERIAL • Acute purulent infection within the subarachnoid space. • Associated with CNS inflammatory reactions that may result in decreased consciousness, seizures, raised ICP etc VIRAL • Usually present with headache, fever and signs of meningeal irritation coupled with inflammatory CSF. • The headache of viral meningitis is often frontal or retro-orbital associated with photophobia and pain on eye movement.
  • 5. • CSF EXAMINATION • HISTOPATHOLOGY • LATEX AGGLUTNATION • POLYMERASE CHAIN REACTION • VIRAL CULTURE • RAPID DIAGNOSTIC TESTS (RDT) • SEROLOGIC STUDIES • OTHER LAB STUDIES
  • 6. • Laboratory examination of the CSF is usually the first step to confirm the presence of meningitis. • Cytological examination should precede centrifugation and heating of CSF.
  • 7. • The typical profile: CSF opening pressure: 50–180 mmH2O Glucose: 40–85 mg/dL. Protein (total): 15–45 mg/dL. Leukocytes (WBC): 0–5/µL (adults / children); up to 30/µL (newborns). Culture: sterile. Gross appearance: Normal CSF is clear and colorless. Differential: 60–70% lymphocytes; up to 30% monocytes and macrophages; other cells 2% or less.
  • 8. • • • • • • Glucose (mg/dL): Protein (mg/dL) WBCs (cells/µL) Cell differential: Culture: Opening Pressure Normal (> 40 mg/dL.) <100 mg/dL (moderate increase) < 100 cells/µL. Early: neutrophils. Late: lymphocytes. Negative Usually normal
  • 9. • • • • • • Glucose (mg/dL): Protein (mg/dL): WBCs (cells/µL): Cell differential: Culture: Opening Pressure: Normal to marked decrease. <40 mg/dL. (Marked increase) > 250 mg/dL. >500 (usually > 1000). Early: May be < 100. Predominance of Neutrophils (PMNs) Positive Elevated
  • 10. • Neutrophils fill the subarachnoid space in severely affected areas and are found predominantly around the leptomeningeal blood vessels in the less severe cases.
  • 11. • Positive reaction: agglutination (or visible clumping) of the latex particles and slight clearing of the suspension occurs within 2-10 minutes . • Negative reaction: the suspension remains homogenous and slightly milky in appearance.
  • 12. • Amplification of virus specific DNA or RNA from CSF using PCR amplification has become the single most effective method for diagnosing CSF viral infections. • It is a highly sensitive and specific test since only trace amounts of the infecting agent's DNA is required. • It may identify bacteria in bacterial meningitis and may assist in distinguishing the various causes of viral meningitis.
  • 13. • The sensitivity of CSF cultures for the diagnosis of viral meningitis is poor in comparison to the detection of bacterial meningitis. • Viruses may also be isolated from throat swabs, blood and urine. • Enterovirus and adenoviruses maybe found in the feces.
  • 14. • Crucial diagnostic tool • Serum antibody detection is less useful for viruses with high prevalence rates in the general population. • For viruses with low prevalence rates , diagnosis of acute viral infection can be made by documenting • Seroconversion between acute phase and convalescent sera. • The documentation of synthesis of virus specific antibodies in CSF is more useful than serum serology alone.
  • 15. • RDTs have been developed for direct testing of CSF specimens without prior heat or centrifugation. • The test is based on the principle of vertical flow immunochromatography. • Gold particles and nitrocellulose membranes are coated with monoclonal antibodies to capture soluble serogroup-specific polysaccharide antigens in the CSF.
  • 16. • Appearance of red lines on the dipsticks will indicate whether one of the four meningococcal serogroups has been detected in the CSF. • The upper line on the dipstick is the positive control and should always be present. • If the CSF is positive for one of the serogroups, a lower red line will also be present. The position of that red line indicates the specific serogroup based on the RDT that was tested. • A negative result consists of a single upper pink control line only.
  • 17. • CBC (complete blood count) & DLC (differential leucocyte count) • Liver and Renal function tests • ESR (erythrocyte sedimentation rate) • C- Reactive protein • Electrolytes etc • MRI and CT are not necessary in patients with uncomplicated meningitis. • They may be performed in patients with altered consciousness, seizures etc

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