Management of bacterial meningitis in children

Posted by e-Medical PPT Saturday, October 9, 2010
The CSF sample is examined for presence and types of white blood cells, red blood cells, protein content and glucose level.Gram staining of the sample may demonstrate bacteria in bacterial meningitis, but absence of bacteria does not exclude bacterial meningitis as they are only seen in 60% of cases and Gram staining is less reliable in particular infections such as listeriosis. Microbiological culture of the sample is more sensitive but results can take up to 48 hours to become available.The type of white blood cell predominantly present indicates whether meningitis is bacterial (usually neutrophil-predominant) or viral (usually lymphocyte-predominant),although in the beginning of the disease this is not always a reliable indicator. Less commonly, eosinophils predominate, suggesting parasitic or fungal etiology.
The concentration of glucose in CSF is normally above 40% that in blood. In bacterial meningitis it is typically lower; the CSF glucose level is therefore divided by the blood glucose (CSF glucose to serum glucose ratio). A ratio less than 0.4 is indicative of bacterial meningitis;in the newborn, glucose levels in CSF are normally higher, and a ratio below 0.6 (60%) is therefore considered abnormal.
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