NDLI: Cerebrospinal fluid/blood glucose ratio as an indicator for bacterial meningitis.

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Cerebrospinal fluid/blood glucose ratio as an indicator for bacterial meningitis.

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Cerebrospinal fluid/blood glucose ratio as an indicator for bacterial meningitis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Tamune, Hidetaka Takeya, Hiroaki Suzuki, Wakako Tagashira, Yasuaki Kuki, Takaie Honda, Hitoshi Nakamura, Mitsuhiro
Description	Author Affiliation: Tamune H ( Department of Emergency Rescue, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. Electronic address: tamune-tky@umin.ac.jp.); Takeya H ( Department of Emergency Rescue, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.); Suzuki W ( Department of Emergency Rescue, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.); Tagashira Y ( Department of Internal Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.); Kuki T ( Department of Internal Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.); Honda H ( Department of Infection Prevention, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.); Nakamura M ( Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.)
Abstract	BACKGROUND: Bacterial meningitis is an emergent disease requiring prompt diagnosis and treatment with appropriate antimicrobials. 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. METHODS: This is a single-center, retrospective review of medical records to determine which emergency laboratory CSF test results are useful for predicting bacterial 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. RESULTS: We identified 15 patients with bacterial meningitis and 129 patients with aseptic 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. CONCLUSION: This study suggests that the CSF/blood glucose ratio may be a better single indicator for bacterial meningitis. 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. It may also help exclude the diagnosis of bacterial meningitis especially in cases in which no microorganisms can be cultured.
File Format	HTM / HTML
ISSN	07356757
Issue Number	3
Volume Number	32
e-ISSN	15328171
Journal	The American Journal of Emergency Medicine
Language	English
Publisher	Elsevier
Publisher Date	2014-03-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Emergency Discipline Medicine Blood Glucose Metabolism Glucose Cerebrospinal Fluid Meningitis, Bacterial Diagnosis Adolescent Adult Aged Aged, 80 And Over Biological Markers Blood Diagnosis, Differential Emergency Service, Hospital Female Humans Leukocyte Count Leukocytosis Etiology Male Meningitis, Aseptic Middle Aged Roc Curve Retrospective Studies Sensitivity And Specificity Young Adult Evaluation Studies Journal Article
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine

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