A patient presents with symptoms of bacterial meningitis. A cerebrospinal fluid

Question

A patient presents with symptoms of bacterial meningitis. A cerebrospinal fluid (CSF) sample is taken and has a cloudy appearance. The CSF sample is cultured on blood agar and results in no bacterial growth. What can be concluded from this result?

The patient may be suffering from bacterial or viral meningitis.

The patient is most likely suffering from meningitis caused by Neisseria meningitidis.

The patient is more likely to be suffering from influenza (flu) rather than meningitis.

The patient is suffering from aseptic meningitis.

The patient does not have bacterial meningitis.

Explanation / Answer

Bacteria reach the subarachnoid space via the bloodstream or, less often, by extension from contiguous structures such as the sinuses or ears. The infection is usually confined to the subarachnoid space, but toxins (from bacteria or leukocytes) can result in edema and also can damage blood vessels, causing additional damage. Patients with bacterial meningitis therefore present with changes in alertness (sensorium) in addition to headache, fever, and meningismus (a stiff neck that is most resistant to flexion.) Intracranial pressure is increased because of cerebral edema and due to interference with the normal circulation and resorption of cerebrospinal fluid (CSF) by the inflammatory process.

Viral meningitis

Although pathologically some cerebral involvement is seen in most cases of viral meningitis, the clinical picture is more often one of pure meningitis: headache, fever, stiff neck, and sometimes lethargy, but with no focal neurologic signs or seizures. When there are signs of cerebral involvement, the process is called meningoencephalitis.

If the CSF looks cloudy, it could mean there is an infection or a build up of white blood cells or protein.

A normal result means no bacteria, viruses, or fungi grew in the laboratory dish. This is called a negative result. However, a normal result doesn't mean that there is no infection. The spinal tap and CSF smear may need to be done again.

When the inflammation isn’t caused by bacteria, the condition is called aseptic meningitis. Viruses cause the vast majority of aseptic meningitis cases, which is why the condition is also known as viral meningitis.

So in the above case, there is no bacterial infection , may be it is asceptic condition . Further tests need to be done. If they are negative may be it is a flu.

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