The CNS infection in the tropical climates is complex because a wide range of pathogens can cause it, including arboviruses, mycobacterium, fungi, protozoa, and helminths, besides pathogens commonly seen in developed countries. This biomarker might be helpful to diagnose tubercular meningitis once bacterial meningitis is ruled out by other methods.Ĭentral nervous system (CNS) infection is ten times more common in developing countries than in developed countries, where clinical diagnosis and empiric treatment without etiological confirmation is the main way of management. Raised CSF ADA (≥10 IU/L) was strongly associated with bacterial and tubercular meningitis. ConclusionsĪddition of molecular method to the conventional culture had enhanced the identification of etiologies of CNS infection. Rural residence (aOR 4.1, 95% CI 1.2–14.4) and raised CSF ADA (≥10 IU/L) (aOR 25.5, 95% CI 3.1–212) were associated with bacterial meningitis when compared with viral meningitis similarly, raised CSF ADA (≥10 IU/L) (aOR 42.2, 95% CI 2.0–882) was associated with tubercular meningitis. Mixed pathogens were detected in 1.8% of the CSF samples. pneumoniae (2.7%) were common bacterial and HSV (2.2%), Echovirus 6 (0.7%), and Echovirus 30 (0.7%) were common viral pathogens detected. Among 408 CSF samples tested by PCR, out of them, 358 were also tested by culture an etiology was identified in 27.5% ( n=112). Five hundred eighty-three patients had abnormal CSF findings (meningoencephalitis) median age was 45 (IQR 31–58), 62.6% were male, and 60.9% were tested for HIV infection. Total number of patients admitted to the department was 7506 among them, 679 were suspected to have CNS infection, and they underwent lumbar puncture. In addition to culture, CSF samples were tested for common bacterial and viral pathogens by polymerase chain reaction (PCR) and for biomarkers: C-reactive protein and adenosine deaminase (ADA). All patients who were ≥ 16 years old and who had meningoencephalitis suggested by abnormal cerebrospinal fluid (CSF) findings (CSF total cell >5/mm3 or CSF protein ≥40 mg/dL) were included in the study. We conducted a cross-sectional study in the Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam, from June 2012 to May 2014. The objectives of this study were to determine the causes of meningitis in adult patients by using molecular assays, to assess the risk factors associated with them, and to explore whether biomarkers can differentiate tubercular meningitis from bacterial meningitis. Tubercular meningitis is one of the common causes of meningitis, which has high morbidity and mortality, but lacks sensitive diagnostic assays. All rights reserved.Laboratory facilities for etiological diagnosis of central nervous system (CNS) infection are limited in developing countries therefore, patients are treated empirically, and the epidemiology of the pathogens is not well-known. It may also help exclude the diagnosis of bacterial meningitis especially in cases in which no microorganisms can be cultured.Ĭopyright © 2014 Elsevier Inc. Since the CSF glucose and blood glucose values are promptly and easily obtained from a lumbar puncture, the CSF/blood glucose ratio should be considered as a timely diagnostic indicator of bacterial meningitis. This study suggests that the CSF/blood glucose ratio may be a better single indicator for bacterial meningitis. While neutrophil-predominant pleocytosis and a decreased glucose level in CSF can predict the presence of bacterial meningitis, the CSF/blood glucose ratio is more precise (optimal cut-off=0.36, sensitivity=92.9%, specificity=92.9%, area under the curve=.97) even after administration of antimicrobials prior to examination in the emergency department. We identified 15 patients with bacterial meningitis and 129 patients with aseptic meningitis. The diagnosis of meningitis is made when the white blood cell count in CSF exceeds 5 cells/μL, while the diagnosis of bacterial meningitis additionally requires the growth of a pathogen from a CSF culture or the identification of a pathogen in Gram staining of CSF specimen. This is a single-center, retrospective review of medical records to determine which emergency laboratory CSF test results are useful for predicting bacterial meningitis. Although the lumbar puncture is widely used as a diagnostic tool for bacterial meningitis, it remains unclear which value in cerebrospinal fluid (CSF) analysis in emergency laboratory tests precisely predicts the presence of bacterial meningitis. Bacterial meningitis is an emergent disease requiring prompt diagnosis and treatment with appropriate antimicrobials.
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