Comparative Evaluation of Macroscopic, Microscopic, Serological and Cultural Examination of CSF in Bacterial Meningitis

Abstract

The Present study was conducted to find out the incidence of meningitis among the patients attending Patan Hospital, Kathmandu, Nepal from May 2007 to March 2008. In this s tudy,464 Cerebrospinal fluid (CSF) samples were collected from suspected mening it is patients. The samples were analyzed for turbidity, total leucocyte count, protein level, gluoselevel and cultured for the isolation of microorganism. In all 464 CSF samples collected, only20 (4.31%) showed positive culture result. Gram positive isolates were predominant. Among the isolates Strep tococcuspneumoniae(45%) followed byHaemophilus influenzae type b,Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus viridans, CitrobacterfreundiiandCryptococcus neoformans were present. Higher number of CSF samples having leucocyte count more than 100 cells/mm were found culture positive. The association of the cell count and culture positivity was found statisticallysignificant (P<0.05). Among the culture positive CSF samples, 60% had low glucose level(>40mg/dl) and 100%hadhigh protein level. Most of the Gram negative isolates were found susceptibleto Chloramphenicol and Cefotaxime and resistant toAmoxycillin. Sensitivity and specificity of macroscopic, microscopic, serological and culture methods usedto analyze the CSF samples for the confirmation of meningitis were assessed. The presentstudy showed the correlation between macroscopic, microscopic, serological and culturalmethods of CSF examination to confirm meningitis. Key words: Meningitis, CSF (Cerebrospinal fluid), cell count, Gram Stain, Latexagglutinationtestfor Hib, Binaxtestfor Pneumococcal antigen