Cerebrospinal Fluid White Cell Count Research Articles

Echovirus type 30 infection associated with aseptic meningitis in Nassau County, New York, USA.

An outbreak of echovirus type 30, primarily affecting infant under 1 year old, was documented in Nassau County, N.Y., USA. Twenty-four of the 40 infected patients were definitively diagnosed with aseptic meningitis. A positive correlation was found between the proportion of polymorphonuclear leukocytes and the overall cerebrospinal fluid white cell count.

Diagnosis of Trypanosoma brucei gambiense sleeping sickness using an antigen detection enzyme-linked immunosorbent assay

A monoclonal antibody-based enzyme-linked immunosorbent assay (antigen elisa) developed for detection of trypanosome antigens in the serum and cerebrospinal fluid (CSF) of patients as a means for diagnosis of Trypanosoma brucei gambiense sleeping sickness was evaluated at the Bureau Central de la Trypanosomiase, Kinshasa, Zaire. Sixty-nine (89·6%) of 77 parasitologically confirmed cases examined at the Daloa clinic had antigens in serum; 35 (45·5%) had antigens in CSF and, in 4 of these, the antigens were detected in CSF only. Taking the serum and CSF results together, 73 (94·8%) of the 77 patients were positive in the assay. In the Kinshasa series, 168 (89·4%) of 188 parasitologically confirmed cases were positive by antigen elisa. The controls, who included 165 blood donors and 40 patients with malaria, 2 with hydatidosis and 12 with leishmaniasis, were negative by antigen elisa. Analysis of CSF results for 35 patients who had antigens in CSF revealed that 34 (97·1%) had elevated CSF white cell counts, 29 (82·9%) had elevated protein levels, and 23 (65·7%) had trypanosomes in their CSF. Moreover, analysis of results for 34 patients whose CSF had been shown to harbour trypanosomes by the double centrifugation technique showed that 24 (70·6%) had antigens in CSF, 28 (82·6%) had elevated protein levels, and 33 (97·1%) had elevated CSF white cell counts. Antigens were rapidly cleared from peripheral circulation following institution of treatment. Antigen clearance was accompanied by a rapid fall in CSF protein levels and white cell counts. These results demonstrate the potential of antigen elisa, not only as a tool for diagnosis, but also for clinical staging and treatment follow-up of patients with T. b. gambiense sleeping sickness.

Cerebrospinal fluid cell counts and chemistries in bacterial meningitis.

We evaluated the records of 428 patients with bacterial meningitis to document initial cerebrospinal fluid (CSF) findings and detail their changes during therapy. Compared to patients with an initial polymorphonuclear cell predominance in the CSF, patients with initial CSF lymphocytosis had lower CSF leukocyte counts, milder CSF chemical abnormalities, and a lower frequency of positive CSF Gram stains and cultures. These findings suggest that CSF lymphocytosis may represent an early phase of infection. A low CSF leukocyte count was associated with a poor outcome, presumably reflecting an inadequate host response to infection. The CSF white cell count increased during the first 24 hours of therapy in 45% of cases. Morbidity and case fatality rates were not significantly increased in this group, suggesting that an initial rise in the CSF leukocyte count does not reflect a poor response to therapy.

Human cerebrospinal fluid somatostatin in neurologic disease

Concentrations of somatostatin-like immunoreactivity (SLI) were examined in human cerebrospinal fluid (CSF). To validate the assay it was shown that CSF which had been run over a somatostatin immunoaffinity column showed no interference with binding of synthetic standards. Reversed phase HPLC showed that the immunoreactive material coeluted with SS14 and SS28 as well as a higher molecular weight precursor. Concentrations of human CSF SLI were stable at both room temperature and 4 °C for up to 72 h while repeated freezing and thawing resulted in a significant loss of immunoreactive material after the 3rd repetition. In normal control patients less than 55 years of age, CSF SLI was 54.7 ± 1.9 pg/ml, while in those older than 55 CSF SLI was 56.2 ± 2.2 pg/ml. Febrile infants had significantly higher levels (75.4 ± 7.3) pg/ml. CSF SLI was normal in patients with aseptic meningitis (54.4 ± 3.4 pg/ml), suggesting that increased CSF protein and white cell counts do not affect concentrations. Concentrations of CSF SLI were significantly increased in intervertebral disc disease (65.1 ± 5.6 pg/ml), intrinsic spinal cord pathology (101.0 ± 23.9 pg/ml), central nervous system tumors (78.0 ± 7.8 pg/ml) and acute cortical damage of varied etiology (277.8 ± 81.6 pg/ml). Patients with pseudotumor cerebri had concentrations of 43.2 ± 2.5 pg/ml. Concentrations of CSF SLI were significantly reduced ( P < 0.01) in multiple sclerosis (38.8 ± 5.5 pg/ml) and old cortical pathology (23.2 ± 3.9 pg/ml). Serial CSF analyses in patients with acute CNS lesions, suggest that CSF SLI may be a neurochemical marker of acute pathology, as the initially elevated levels fell to or below normal with resolution of the pathologic process.

Unreliability of β-2-microglobulin in early detection of central nervous system relapse in acute lymphoblastic leukemia

The value of serial determination of the cerebrospinal fluid (CSF) β-2-microglobulin ( β 2m) level for early detection of acute lymphoblastic leukemia (ALL) in the central nervous system (CNS) has been prospectively studied in 30 children. β 2m was determined by micro-ELISA assay. Results demonstrated a sensitivity of 40% (95% confidence interval, 5.3–85.3%) and a predictive value of 8% (95% confidence interval, 1.0–26.0%). In post-irradiation syndrome, as well as in viral infection with cytopathological changes of white cells in CSF, β 2m values proved to be significantly higher than in incipient CNS relapse, and these conditions, or an unknown cause, are more often associated with β 2m elevation than CNS relapse. No relation was found between CSF white cell counts and β 2m levels. It is concluded that β 2m is not an appropriate test for early detection of CNS involvement in children with acute lymphoblastic leukemia.

Pneumococcal Meningitis: A Clinical and Laboratory Study

Forty-two patients who were admitted consecutively with pneumococcal meningitis during an 18-month period were studied in Ahmadu Bello University Hospital, Zaria, Nigeria. The disease was seen most frequently in older children and young adults. A predisposing condition was found in only four patients. Counter-current immunoelectrophoresis was found to be a rapid and effective method of diagnosis: pneumococcal polysaccharide antigen was found in the initial cerebrospinal fluid (CSF) sample from all but one of the patients. Detailed physiological studies carried out in two patients showed profound disturbances of cerebral carbohydrate metabolism and an increase in cerebral vascular resistance. Twenty patients died (48 per cent) in spite of treatment with large doses of penicillin. A fatal outcome was associated with impairment of consciousness on admission, a low CSF white cell count and a high CSF antigen titre. It is suggested that marked changes in cerebral carbohydrate metabolism, and perhaps vascular damage, play important roles in producing severe brain damage in patients with pneumococcal meningitis and that defective CSF polymorphoneutrophil leukocyte function may contribute to the failure of the infection to respond satisfactorily to antibiotic therapy.

Changes in the CSF during pneumoencephalography.

The changes in the cerebrospinal fluid (CSF) during lumbar air encephalography were studied in 165 patients. Significant changes occurred only in the cell count and protein concentration. A predominantly lymphocytic pleocytosis of greater than 2 cells per cu mm appeared in 60% of cases, the cellular reaction being proportional to the time between initial and final CSF samples, and greater when the initial CSF white cell count exceeded 5 cells/mm3 and/or in disorders associated with an intracranial inflammatory reaction. A relatively constant decrease in the total CSF protein content of approximately 20% of the initial value was noted, and was felt to be due primarily to partial dilution of the lumbar CSF by ventricular and cisternal fluid.—In view of the wide individual variations in the changes in protein content, particularly in the borderline abnormal range, it is recommended that only the initial CSF specimen be used for biochemical and cellular analysis, to avoid diagnostic confusion.