Cerebrospinal Fluid Exam Research Articles

Etiology of bacterial meningitis among children aged 2-59 months in Salvador, Northeast Brazil, before and after routine use of Haemophilus influenzae type B vaccine.

To describe the frequency of etiologic agents of bacterial meningitis (BM) among children aged 2-59 months in a sample of patients in Salvador, Northeast Brazil, with emphasis on the frequency of BM of unknown etiology (BMUE), just before, during and after the implementation of routine immunization of infants with Haemophilus influenzae type b (Hib) vaccination. Demographic, clinical and cerebrospinal fluid (CSF) information was collected from the chart of every patient, aged 2-59 months, whose CSF exam was performed at the CSF Lab - José Silveira Foundation, between January 1989 and December 2001. Every CSF exam was completely performed according to standard methods. The etiologic diagnosis was based on either culture and/or latex-agglutination test. When the agent was only seen on Gram stained smear, the diagnosis was descriptive. BMUE was defined as: glucose < 40mg / dl, protein > 100 mg / dl, white blood cell count > 20 cells / mm(3), percentage of neutrophils > 80%. Of 1519 patients, 894 (58.9%) had normal exams and BM was diagnosed in 95 (6.2%). Etiologic agents were: Hib (44.2%), meningococcus (13.7%), Gram-negative bacilli (11.6%), Mycobacterium tuberculosis (6.3%), pneumococcus (4.2%), other agents (4.2%); BMUE was diagnosed in 15.8% of cases with BM. By analysing the frequency of BMUE and Hib among all exams performed yearly, the peaks were recorded in 1989 (5.3%) and 1990 (16.9%), respectively, decreasing to 0.7% and 0% in 2001. It is possible that the implementation of the conjugate Hib vaccine during the 1990's has been decreasing not only the occurrence of Hib meningitis but also of BMUE.

Frequency of lymphocytic meningitis associated with mumps before and after a mass campaign for mumps vaccination in children from Salvador, Northeast Brazil.

To describe the frequency of lymphocytic meningitis(LM) concomitant with mumps, before and after the mumps mass immunization campaign in 1997. Demographic, clinical and cerebrospinal fluid(CSF) information was collected from the chart of all patients aged from 2 to 59 months, whose CSF exam was performed at the CSF Lab/FJS, between 1989 and 2001. LM was defined as pleocytosis composed by lymphomononuclear cells and negative exams for bacterial or mycologic infection. Of 1,519 patients, 894(58.9%) had normal exams. LM was present in 301(19.8%) patients, out of which 22(7.3%) had concomitant mumps. The frequency of LM ranged from 15.8% in 1989 to 19.7% in 2001 and of LM with concomitant Mumps ranged from 10.5% in 1989 to 4.7% in 1995, when the last cases were registered. It is probable that the mumps vaccine campaign has influenced the absence of LM with concomitant Mumps, from 1996 to 2001.

Clinical and cerebrospinal fluid (CSF) profile and CSF criteria for the diagnosis of spinal cord schistosomiasis.

To describe the clinical and CSF findings among patients with presumptive neuroschistosomiasis (NS) and to suggest a classification for the CSF diagnosis of presumptive NS. The charts of all patients whose CSF exam was performed at the CSF Lab, Jos Silveira Foundation, Salvador, Brazil, from 1988 to 2002 were reviewed. Those with clinically suspected NS whose indirect fluorescent antibody test (IFA) and or hemagglutination-inhibiting antibodies test (HAI) were positive to S. mansoni were identified. Of 377 patients, 67.9% were males; the median age was 36 years (mean 37 + 16 yrs, range 3-82 yrs). The most frequent complaints were paraparesis (59.9%), urinary retention (36.2%), lower limb pain (22.8%). WBC of CSF (count/mm ) was > 4 in 66.0% (mean 83 + 124, median 40, range 4.3-1,100), protein (mg/dl) was > 40 in 84.6% (mean 185 + 519, median 81, range 41-6,800) and eosinophils were present in 46.9%. IFA and HAI were positive in 75.3%. WBC > 4 and presence of eosinophils were associated with IFA and HAI positive (67.3% versus 51.4%, p 0.014; 49.1% versus 23.0%, p 0.0001, respectively) and protein > 40 was not (85.4% versus 77.0%, p 0.09). Presence of WBC > 4, protein > 40 and eosinophils was associated with IFA and HAI positive (71.6% versus 38.2%, p 0.0003) but presence of eosinophils and any other combination of WBC and protein were not. NS should be considered as a possible diagnosis in patients who had had contact with schistosome-infected water and present with spinal cord compromising. Presence of IFA and HAI positive to S. mansoni, WBC > 4, protein > 40 and presence of eosinophils in the CSF may be considered as a criterium of highly probable presumptive diagnosis.

Neurologic aspects of eclampsia

The difficult types of preeclampsia and eclampsia are presented with the neurological symptoms. The break of cerebral autoregulation mechanism plays the most important role in pathogenesis of cerebral vasospasm. Nevertheless, eclampsia isn't just an ordinary hypertensive encephalopathy because other pathogenic mechanisms are involved in its appearance. The main neuropathologic changes are multifocal vasogenic edema, perivascular multiple microinfarctions and petechial hemorrhages. Neurological clinical manifestations are convulsions, headache, visual disturbances and rarely other discrete focal neurological symptoms. Eclampsia is a high-risk factor for onset of hemorrhagic or ischemic stroke. This is a reason why neurological diagnostic tests are sometimes needed. The method of choice for evaluation of complicated eclampsia is computerized brain topography that shows multiple areas of hypodensity in occipitoparietal regions. These changes are focal vasogenic cerebral edema. For differential diagnosis of eclampsia and stroke other diagnostic methods can be used--fundoscopic exam, magnetic resonance brain imaging, cerebral angiography and cerebrospinal fluid exam. The therapy of eclampsia considers using of magnesium sulfate, antihypertensive, anticonvulsive and antiedematous drugs.

Etiology of bacterial meningitis in a cohort from Salvador, Bahia

Bacterial meningitis remains a very important disease world-wide, mainly during childhood. In order to describe the etiology of bacterial meningitis among some children in Salvador, Bahia-Brazil, we retrospectively reviewed 7000 cerebrospinal fluid exams, performed within the period of September 1988 up to August 1995, at the CSF Laboratory, José Silveira Foundation; 892(12.7%) exams met the inclusion criteria; patients less than 16 years of age and clinical meningitis diagnosis. Among 139 cases of bacterial meningitis, H. influenzae type b (Hib) was the most frequent cause (26.0%), all of the cases in children under 5 years. We have been questioning whether the declining Hib disease trend since 1992 has been associated with the use of Hib conjugate vaccines among those children.

Cerebrospinal fluid in cerebrovascular disorders. Study of 1500 cases

In order to evaluate information on acute stroke through the study of cerebrospinal fluid (CSF) data em 1500 patients were analysed in the first 48 hours following stroke. Cases were distributed in three groups according to CSF basic findings: type 1, CSF without erythrocytes and without xanthochromia; type 2, CSF without erythrocytes and with xanthochromia; type 3, CSF with erythrocytes and with xanthochromia. Data on each type are discussed as well as correlation findings. Systemic metabolic disturbances, blood-brain barrier impairment and central nervous system lesions are discussed as to the role they have in CSF changes observed in stroke. Indication of CSF exam in stroke is reviewed taking into account progress in neuroimaging techniques.

1084 UNUSUAL LABORATORY FINDINGS IN ECHOVIRUS-11 MENINGITIS

Echovirus 11(E-11) was isolated from the cerebrospinal fluid (CSF) of 22 children in a 1980 summer outbreak of meningitis. Seventeen(77%) were <6 mos old(range 2 wk-9 yr). 54% had CSF cell counts >300/mm3 and 14% had >500/mm3(range 0-2250). 59% had ≥50% polymorphonuclears(P) and 24% had >90% P. None had CSF glucose <40mg/dl; 41% had CSF protein ≥45mg/dl and 6% had >75mg/dl. Three patients(pts) had entirely normal CSF. In 86% peripheral WBC was 5000-15000/mm3; only 3 had >75% P but 20% had absolute band count >500/mm3 Four pts(<3 mos old) had repeat CSF exams. All had >50 cells/mm3 and the two youngest(age 2 wk) still had >50% P after 1 and 3 days. CSF findings were compared with data from pts with bacterial meningitis(B). Cell count >500/mm3, glucose ≤45mg/dl, and protein >75mg/dl were statistically associated with B. However, 14% of E-11 pts had at least one of these findings and 20% of B pts had none of these findings. CSF P >75% was as frequent in E-11 pts as in B pts. Peripheral WBC <5000 or >15000/mm3 and absolute band count >500/mm3 were statistically associated with B but 38% of E-ll pts had one of these abnormalities.Certain CSF findings in our pts have not been reported for E-11 and are uncharacteristic of viral meningitis: 1) leukocyte response more characteristic of bacterial meningitis: CSF P >90%, persistence of CSF P beyond 24 hrs, peripheral band count >500, and 2) entirely normal CSF.