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Lab diagnosis of meningitis, Lecture notes of Medicine

Baba Farid University of Health SciencesMedicine

Practical point of view.............

Typology: Lecture notes

2022/2023

Uploaded on 06/21/2024

jasmeet-jaggi
jasmeet-jaggi 🇮🇳

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Laboratory Diagnosis of Meningitis
1. Introduction
Meningitis is the inflammation of the meninges, the protective membranes covering the brain
and spinal cord. It can be caused by bacterial, viral, fungal, or parasitic infections.
Organisms causing Meningitis
1.Bacterial Meningitis
Neonates (0-1 month)
oGroup B Streptococcus(Streptococcus agalactiae)
oEscherichia coli
oListeria monocytogenes
Infants and Children (1 month - 5 years)
oHaemophilus influenzaetype b (Hib)
oNeisseria meningitidis(meningococcus)
oStreptococcus pneumoniae(pneumococcus)
Adolescents and Young Adults (5-24 years)
oNeisseria meningitidis
oStreptococcus pneumoniae
Adults (25-60 years)
oStreptococcus pneumoniae
oNeisseria meningitidis
oHaemophilus influenzae(less common due to vaccination)
Elderly (>60 years)
oStreptococcus pneumoniae
oNeisseria meningitidis
oListeria monocytogenes
2.Viral (Aseptic) Meningitis
Enteroviruses(e.g., Coxsackievirus, Echovirus)
Herpes Simplex Virus (HSV)
Varicella-Zoster Virus (VZV)
Mumps Virus(especially in unvaccinated individuals)
Human Immunodeficiency Virus (HIV)
West Nile Virus
3.Fungal Meningitis
Cryptococcus neoformans(most common in immunocompromised individuals, such as
those with HIV/AIDS)
Candida species
Coccidioides species
pf3

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Laboratory Diagnosis of Meningitis

1. Introduction Meningitis is the inflammation of the meninges, the protective membranes covering the brain and spinal cord. It can be caused by bacterial, viral, fungal, or parasitic infections. Organisms causing Meningitis 1. Bacterial MeningitisNeonates (0-1 month) o Group B Streptococcus (Streptococcus agalactiae) o Escherichia coli o Listeria monocytogenesInfants and Children (1 month - 5 years) o Haemophilus influenzae type b (Hib) o Neisseria meningitidis (meningococcus) o Streptococcus pneumoniae (pneumococcus)  Adolescents and Young Adults (5-24 years) o Neisseria meningitidis o Streptococcus pneumoniaeAdults (25-60 years) o Streptococcus pneumoniae o Neisseria meningitidis o Haemophilus influenzae (less common due to vaccination)  Elderly (>60 years) o Streptococcus pneumoniae o Neisseria meningitidis o Listeria monocytogenes 2. Viral (Aseptic) MeningitisEnteroviruses (e.g., Coxsackievirus, Echovirus)  Herpes Simplex Virus (HSV)Varicella-Zoster Virus (VZV)Mumps Virus (especially in unvaccinated individuals)  Human Immunodeficiency Virus (HIV)  **West Nile Virus

  1. Fungal Meningitis**  Cryptococcus neoformans (most common in immunocompromised individuals, such as those with HIV/AIDS)  Candida speciesCoccidioides species

Histoplasma capsulatum

4. Parasitic MeningitisNaegleria fowleri (primary amoebic meningoencephalitis)  Acanthamoeba species (granulomatous amoebic encephalitis)  Toxoplasma gondii (especially in immunocompromised individuals) 2. Specimen Collection and HandlingSpecimen: Cerebrospinal fluid (CSF) is the primary specimen for diagnosing meningitis.  Collection Method: Lumbar puncture (spinal tap) is performed to obtain CSF.  Precautions: Ensure aseptic technique to prevent contamination. Collect 3-4 ml of CSF in sterile containers. 3. CSF Analysis 1. Physical Examination o Color: Normal CSF is clear and colorless. Cloudiness may indicate infection. o Turbidity: Increased turbidity suggests higher white blood cell (WBC) count or protein levels. 2. Chemical Analysis o Glucose: Compare CSF glucose with blood glucose. Lower levels in CSF suggest bacterial meningitis. o Protein: Elevated protein levels may indicate infection. 3. Microscopic Examination o Cell Count: Increased WBC count is a common indicator of meningitis. o Gram Stain: A direct smear of CSF is stained to identify bacteria.  Gram-positive bacteria stain purple.  Gram-negative bacteria stain pink. o India Ink Stain: Used for detecting Cryptococcus species in fungal meningitis. 4. Microbiological CultureBacterial Culture: CSF is cultured on blood agar, chocolate agar, and MacConkey agar. o Incubation: Plates are incubated at 37°C for 18-24hours o Colony Identification: Observe colony morphology, hemolysis patterns, and perform biochemical tests for species identification.  Viral Culture: CSF may be cultured in cell lines, although PCR is more commonly used.  Fungal Culture: Sabouraud dextrose agar is used to culture fungi  5. Molecular DiagnosisPolymerase Chain Reaction (PCR): Used for detecting bacterial, viral, or fungal DNA/RNA in CSF. Highly sensitive and specific.