1. In the name of Allah

2. ROLE OF CEREBROSPINAL
FLUID IN THE DIAGNOSIS OF
MENINGITIS
IHSAN ALI
TRAINEE TECHNOLOGIST
AKUH

3. What is meningitis?……
The brain and spinal cord are covered by connective
tissue layers collectively called the meninges which form
the blood-brain barrier.
1-the pia mater (closest to the CNS(
2-the arachnoid mater
3-the dura mater (farthest from the CNS(.
The meninges contain cerebrospinal fluid (CSF).
Meningitis is an inflammation of the meninges, which, if
severe, may become encephalitis, an inflammation of
the brain.

4. What is Meningitis?
Meningitis can be caused by many different
organisms including viruses and bacteria.
Meningitis, caused by a bacteria, is life threatening
and requires urgent medical attention and treatment
with antibiotics.
Meningitis caused by a virus is very rarely life
threatening but can cause the body to become very
weak.
When bacteria invade the body they can cause
meningitis, septicaemia or meningitis and
septicaemia together

5. Causes of Meningitis
-Bacterial Infections
-Viral Infections
-Fungal Infections
)Crypto co ccus ne o fo rm ans
Co ccidio de s im m itus(

6. Bacterial meningitis…..
Etiological Agents:
Pneumococcal, Stre pto co ccus pne um o niae
(38 %(
Meningococcal, Ne isse ria m e ning itidis (1 4%(
Hae m o philus influe nz ae (4%(
Staphylococcal, Staphylo co ccus aure us (5%(
Tuberculous, Myco bacte rium tube rculo sis

7. Viral Meningitis
Etiological Agents:
Enteroviruses (Coxsackie's and echovirus): most common.
-Adenovirus
-Arbovirus
-Measles virus
-Herpes Simplex Virus
-Varicella

8. Symptoms of Meningitis
Meningitis may not always be easy to detect, in
early stages the symptoms can be similar to
flu. They may develop over one or two days,
but sometimes develop in a matter of hours.
It is important to remember that symptoms do
not appear in any particular order and some
may not appear at all.

9. Symptoms formeningitis:
:Babies and Young Children
-High temperature, fever, possibly with cold hands and feet
-Vomiting or refusing feeds
-Whimpering cry
-Blank, staring expression
-Pale, blotchy complexion
-Stiff neck
-Arched back
-Difficult to wake or lethargic
-The fontanelle (soft spot on babies heads) may be tense or
bulging.

10. OlderChildren and Adults
-High temperature, fever, possibly with cold hands and
feet.
-Vomiting, sometimes diarrhoea.
-Severe headache.
-Joint or muscle pains, sometimes stomach cramps.
-Neck stiffness (unable to touch the chin to the chest(
-Dislike of bright lights.
-Drowsiness.
The patient may be confused or disorientated. Fitting may
also be seen.
A rash may develop.

11. LUMBER PUNCTURE

12. LUMBER PUNCTURE:

13. CSF NORMAL COMPOSITION
AND PRESSURE
Normal opening pressure in adults is
90~180mmH2O, 10~100mmH2O in children.
Colour less
>5RBCs
>5WBCs
Protein 23-38 mg/dl
Glucose 60% of serum level(50-80(

14. Elevated pressure
Acute Purulent Meningitis
Tuberculous Meningitis
Viral Menigitis
Cerebral edema
Mass lesion

15. Glucose
The normal Glucose is about 60% compared to serum
level.
Normal 50~80mg/dl
Viral meningitis > 50% of serum level
Decreased Glucose
Bacterial Meningitis(very low(

16. Protein
Over 80% of CSF protein content is derived from
the plasma.
An increased CSF protein serves as a useful but
nonspecific indicator of disease.
Normal level 23~38mg/dl.
Elevated in all infectious meningitis
May remains elevated for months post
meningitis (Viral or Bacterial(

17. White Blood cells count
Total WBC,s Count
Prepare 1:2 Dilution with Turk solution
Charge on Neubeur Chamber
Count in 4 large (WBC,s(squares
Differential WBC,s Count
Centrifuge CSF
Prepare slide from Deposit
Stain with Leishman stain

18. White Blood cells in CSF
>5White Blood cells
Increased in Bacterial Meningitis (Neutrophills(
Increased in Viral Meningitis (lymphocytes(
Increased in Tuberculosis Meningitis
(Neutrophills , Lymphocytes(

19. Culture of CSF
CSF Contains few organisms so concentration is
required
Centrifuge at 10000rpm for 10 mins
Sediments is used for cultures
Media Used
Chocolate Agar
Macconkey Agar
Blood Agar

20. LATEX PARTICAL
AGGLUTINATION TEST (LPA(
ANTIGEN & ANTIBODY REACTION
Keep CSF for 5 mins in boiling water
Exposure of Antigen
Treated with anti-sera
Agglutination Positive
For Bacteria.

21. Thank You