Assessment of Cerebrospinal Fluid (CSF) to Differentiate between Bacterial Meningitis and Viral Meningitis

Objective: To analyze cerebrospinal fluid (CSF) in acute bacterial and viral meningitis patients and differentiating between bacterial and viral meningitis upon the changes observed in CSF compositions.

Methodology: This was a hospital based study conducted from June 2016 to November 2017 in the infectious disease unit of Chattagram Maa-O-Shishu general hospital, Chittagong. The admitted patients who fulfilled the criteria were included in the study. The CSF analysis was done on the first spinal tap and it contained protein level, lactate level, glucose, cell count, Gram’s stain and culture. Blood count, blood glucose, blood culture were also investigated for all the patients.

Results: A total 93 patients were included in the study. Out of 35 bacterial meningitis patients, S. pneumoniae, N. meningitidis and E. coli were found in 51.43% whereas 48.57 were culture negative. Both CSF protein and lactate values were found higher in bacterial than in viral meningitis, with mean 298.33 ± 88.32 and 95.05 ± 49.42 mg/dl (p value <0.001) respectively and 8.35 ± 3.18 mmol/L and 3.4 ± 5.62 mmol/L (p value <0.001) respectively. Higher leukocyte count was also found in bacterial than in viral meningitis, 22.82 ± 6.71 and 10.43 ± 4.31 cell/culture (p value <0.001) respectively. However, lower CSF glucose level was found in bacterial than in viral patients, with mean 175.67 ± 49.87 and 132.26 ± 38.72 mg/dl (p value <0.001) respectively.

Conclusion: CSF analysis (CSF protein, lactate, glucose values), as well as blood glucose and leukocyte count, may provide a reliable, rapid way to differentiate between acute bacterial from viral meningitis which may come into the aid in disease management.