Impact of Immune Status on CSF Profiles in Confirmed Viral, Bacterial, and Fungal Meningitis/Encephalitis
Sarah Thomas1, Kailyn Hayes2, Zi Ling Huang3, Hai Ethan Hoang4, Kiran Thakur5, Rachelle Dugue3
1Morehouse School of Medicine, 2Meharry Medical College, 3Stanford School of Medicine, 4Weill Cornell Medicine, 5Columbia University College of Physicians and Surgeons
Objective:
Characterize cerebrospinal fluid (CSF) profiles of immunocompetent versus immunocompromised adults with confirmed infectious meningitis/encephalitis and identify predictors of CSF profiles.
Background:
Immunocompromise impacts the inflammatory response and infectious disease presentations. Widely accepted CSF values often guide the management of meningitis/encephalitis despite atypical profiles having been described. It is unclear to what extent immune status impacts CSF profiles in infectious meningitis/encephalitis.
Design/Methods:
Adults (≥18 years) admitted between 2010–2021 with bacterial, fungal, or viral meningitis/encephalitis (by ICD-9/10 codes) were identified retrospectively and confirmed by CSF DNA/RNA pathogen testing or culture. Immunocompromised status included HIV/AIDS, active malignancy or chemotherapy, organ/marrow transplantation, chronic corticosteroid/immunosuppressants, congenital immunodeficiency, or asplenia. Linear regression examined immunocompromise, age, sex, and antimicrobial exposure before lumbar puncture(LP) as predictors of CSF profiles. Mann–Whitney U tests with bootstrapped 95% confidence intervals compared groups.
Results:
In viral cases (N=85), immunocompromise predicted lower CSF white blood cell counts (WBC) (ß=-1.43, p<0.0001); older age, male sex, and antimicrobial exposure prior to LP also predicted lower CSF WBC (p<0.05). Immunocompromised patients (N=21) had significantly lower CSF WBC (median[95%CI], 33 cells/µL [18-97] vs 185 [127-263]) and protein (64 mg/dL [ 53- 86] vs 93.5 [,86-105]), p<0.05.
In fungal cases(N=54), immunocompromise significantly predicted lower CSF protein (ß=-0.56,p<0.05). Immunocompromised patients (N=23) had significantly lower CSF WBC (median[95%CI], 39 cells/µL [13-68] vs 136 [76-243]) and protein (78 mg/dL [61-98] vs 119 mg/dl [96-166]), p<0.05.
In bacterial cases (N=52), there were no significant predictors of CSF profiles.
Conclusions:
Immunocompromise was associated with lower CSF WBC and protein levels in viral and fungal but not bacterial meningitis/encephalitis, and should be considered when interpreting CSF profiles.
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