CSF Profiles of Immunocompromised Patients with Bacterial and Viral Meningitis
Sarah Thomas1, Kailyn Hayes2, Hai Hoang3, Kiran Thakur4, Rachelle Dugue5
1Morehouse School of Medicine, 2Meharry Medical College, 3Weill Cornell Medical College and New York Presbyterian Hospital, 4Columbia University College and New York Presbyterian Hospital of Physicians and Surgeons, 5Stanford School of Medicine
Objective:

This retrospective pilot study seeks to characterize cerebrospinal fluid profiles (CSF) of immunocompetent versus immunocompromised patients with confirmed infectious meningitis/encephalitis.  


Background:

There are widely accepted ranges of typical CSF values used to guide diagnosis and treatment of suspected infectious meningitis/encephalitis in healthy individuals. However, it is unclear whether these values should routinely be applied to immunocompromised patients. Atypical CSF profiles may impact timely diagnostics, treatment, and clinical outcomes.  


Design/Methods:

A retrospective database of patients with confirmed infectious bacterial or viral meningitis/encephalitis, admitted between 2010-2021, was constructed. Patients ≥18 years old, identified via ICD-9/10 codes for infectious meningitis/encephalitis were included. Demographic data, serum, CSF, imaging, and clinical data including immune status were collected.  


Results:

Of 65 definitive bacterial meningitis/encephalitis cases, 42 patients were immunocompromised.  Immunocompromised patients had a mean adjusted CSF WBC count of 2366 cells/μL ± 537 with 91.9 ± 20.9% neutrophils, CSF protein of 241.5 mg/dL ± 32.7, and glucose ratio of 0.33 ± 0.05. Immunocompetent patients had a mean CSF WBC count of 3323 cells/μL ± 1244 with 75.7% ± 6.5% neutrophils, CSF protein of 321.4 mg/dL ± 61.4, and glucose ratio of 0.32 ± 0.06. There were 62 definitive viral meningitis/encephalitis cases. 32 patients were immunocompromised, with a mean CSF WBC count of 73.6 cells/μL ± 17.0 with 63.7% ± 3.9% lymphocytes, CSF protein of 115.8 mg/dL ± 23.2, and glucose ratio of 0.49 ± 0.02. Immunocompetent patients had a mean CSF WBC count of 468 cells/μL ± 81.8 (p<0.05) with 72.6% ± 3.6% lymphocytes, CSF protein of 105.2 mg/dL ± 6.4, and glucose ratio of 0.51 ± 0.01. 


Conclusions:

This study suggests that immunocompromised patients with infectious meningitis/encephalitis may have differing, atypical CSF profiles; this may impact timely diagnosis and clinical course. Multi-site collaboration with pooling of retrospective databases to increase generalizability of findings and validate this hypothesis is pending.  


10.1212/WNL.0000000000211849
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