Lab Case 141 – Interpretation

A 44 year old with a headache and signs of meningitis has an LP performed1. Three causes:

Infection – partially treated bacterial/ aseptic

Autoimmune/ Malignancy

SAH

based on CSF – likely to be viral meningitis

  1. Four  Abnormalities:

Low Polymorphs/ high lymphocytes/ high protein/ normal glucose/ no bacteria indicates viral

Against viral is turbid CSF

Against SAH is reducing RCC in 3 samples almost down to 0

Malignancy/ autoimmune unlikely based on above, but must be kept in mind.

  1. Other tests:

CSF

  • viral PCR/ nucleic acid detection test for HSV/ enterovirus/ VZV/ other (HIV/Cryptococcus etc)
  • bacterial PCR/ nucleic acid detection test for Neisseria M/ Strep Pneumoniae
  • India ink – cryptococcus
  • Await culture
  • Auto immune tests as indicated

Other

  •  bloods, including cultures if indicated
  • CXR
  • Urine

This patient developed shingles  a couple of days later and her CSF had VZV

 

 

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