From: S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version)
Parameter | Diagnostic (first) LP | Remarks / Special features |
---|---|---|
Cell count (CC) / μLμL | „typical "CC ≥1000: ca. 80% Mean (SD): 7753 (14736) CC 100–999: 14% CC < 100: 7% | [16] Cave „apurulent BM": do not discontinue antibiotic treatment when CC is low, but CSF lactate or protein values are high! |
S. pneumoniae | Median (IQR): 1842 (291–4419) CC > 999: 75.8-78% CC < 100: 17-19.3% CC < 10: 5% | |
N. meningitidis | Median (IQR): 5328 (1590–12.433) CC > 999: 80-82% CC 100–999: 6.5-11%; CC < 100: 9-11.6%, initial CSF normal: 1.7% (CC ≤5/μL, TP ≤0.50 g/l und Glucose ratio CSF / blood ≥0.40) | |
L. monocytogenes | Median (IQR): 680 (291–1545) CC < 100: 11% | [99] (n = 30 + 62) |
H. influenzae b | Median (Min-Max): 1470 (0–11,400) CC > 999: 92.9%; CC 100-999: 7% CC < 100: 0% | [14] (n = 11) [24] |
B-streptococci | Median (Min-Max): 1230 (0-80,000) CC „normal": 6% | [57] (n = 242) |
Newborn meningitis | CC ≤ 3: 10% | [54] |
Differential Cell count | „typical "= granulocytic | |
S. pneumoniae | ≤20% Granulocytes: 5.9% | [24] |
N. meningitidis | ≤20% Granulocytes: 8.2% | [24] |
L. monocytogenes | < 50% Granulocytes: 26% | [99] |
H. influenzae b | ≤20% Granulocytes: 4.3% | [24] |
B-Streptococcus | Median (Min-Max): 87 (0-100) % | [57] |
Total protein (TP) in mg/l | „typical "TP > 1000 Mean (SD): 4900 (4500) | [16] |
S. pneumoniae | Median (IQR): 2700 mg/l (1400–5800) | [136] |
N. meningitidis | Median (IQR): 4500 mg/l (2200–7000) | [68] |
L. monocytogenes | Median (IQR): 2500 mg/l (1760–3650) | [99] |
H. influenzae b | Median: 1800 mg/l | [14](n = 11) |
B streptococci | Median (Min-Max): 2480 mg/l (200-16,000) | [57] |
Newborn meningitis | TP < 400: 0% TP 410-1200: 24% TP > 1200: 76%, | [54] |
Lactate (mmol/L) | „typical "Lactate ≥3.5 l diverging reference ranges, recommended cut-off: 3.9 mmol/L (=35 mg/dl) Man (SD): 16.51 (6.1) Median (IQR): 9.9 (6.8-12.9) mmol/L | |
DD bacterial versus viral meningitis | Lactate as sensitive differentiation criterion (Meta-analysis: [79, 152]) Sensitivity untreated BM: 98% Sensitivity after preantibiosis: 49% | Cave: Lactate increase also found in status epilepticus, cerebral infarction, ICB, Tumor, Herpes encephalitis [152] |
Macroscopy / Gram staining | positive 63-72% no preantibiosis: 63% with preantibiosis: 62% | [24] (n = 667); [130] |
S. pneumoniae | positive: 85.2% | [24] (n = 162) |
N. meningitidis | positive: 72.5-89% | |
L. monocytogenes | positive: 37% | [99] |
H. influenzae b | positive: 83.3% | [24] (n = 72) |
CSF culture | Positive no preantibiosis: 65.8-88%, positive with preantibiosis: 61.4-70% | |
S. pneumoniae | positive: 75-87% | |
N. meningitidis | positive: 79.5% | [24] |
H. influenzae b | positive: 50% | [24] |
Blood culture | positive no preantibiosis: 66% positive with preantibiosis: 48% | |
S. pneumoniae | positive: 42.6-67% | |
N. meningitidis | positive: 12.6 -57% | |
L. monocytogenes | positive: 61% | [99] |
H. influenzae b | positive: 50% | [24] |
Newborn meningitis | positive: 62% | [54] (n = 92) |