Characterizing Cerebrospinal Fluid Profiles of Immunocompromised Patients with Infectious Meningitis/Encephalitis - European Medical Journal

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Characterizing Cerebrospinal Fluid Profiles of Immunocompromised Patients with Infectious Meningitis/Encephalitis

1 Mins
Neurology
Authors:
Sarah Thomas , 1 Kailyn Hayes , 2 Hai Ethan Hoang , 3 Kiran Thakur , 4 * Rachelle Dugue 5
  • 1. Morehouse School of Medicine, Atlanta, Georgia, USA
  • 2. Meharry Medical College, Nashville, Tennessee, USA
  • 3. Weill Cornell Medical College/New York Presbyterian Hospital, USA
  • 4. Columbia University Irving Medical Center, New York, USA
  • 5. Stanford University School Medicine, California, USA
*Correspondence to [email protected]
Disclosure:

The authors have declared no conflicts of interest.

Acknowledgements:

The authors would like to thank the REACH-HBMC program.

Citation:
Keywords:
Bacterial meningitis, cerebrospinal fluid (CSF), encephalitis, immunocompromised, meningitis, viral meningitis, white blood cell (WBC).

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

BACKGROUND

There are widely accepted ranges of typical cerebrospinal fluid (CSF) values used to guide diagnosis and treatment of suspected infectious meningitis/encephalitis in healthy individuals.1,2,3 However, it is unclear whether these values should routinely be applied to immunocompromised patients. Atypical CSF profiles may impact timely diagnostics and treatment, affecting clinical outcomes.4 In this study,5 the authors aimed to characterize CSF of immunocompetent versus immunocompromised patients with confirmed infectious meningitis/encephalitis.

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 International Classification of Diseases (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 71 definitive bacterial meningitis/encephalitis cases, 46 patients were immunocompromised. Immunocompromised patients had a mean adjusted CSF white blood cell (WBC) count of 3,035±558 cells/μLwith 76.77±3.66% neutrophils, CSF protein of 245±31.4 mg/dL, and glucose ratio of 0.35±0.05. Immunocompetent patients had a mean CSF WBC count of 3192±1147 cells/μL with 77.52±5.58% neutrophils, CSF protein of 245±31.4 mg/dL, and glucose ratio of 0.32±0.05. There were 110 definitive viral meningitis/encephalitis cases. Fifty-eight patients were immunocompromised, with a mean CSF WBC count of 120.18 cells/μL±36.8 with 63.5±3.9% lymphocytes, CSF protein of 116±23.2 mg/dL, and glucose ratio of 0.49±0.02. Immunocompetent patients had a mean CSF WBC count of 422.1 cells/μL±71.5 with 72.4±3.5% lymphocytes, CSF protein of 103.3±6.1 mg/dL, and glucose ratio of 0.52±0.01.

DISCUSSION AND CONCLUSION

There were no differences in bacterial meningitis/encephalitis CSF profiles between immunocompetent and immunocompromised patients. However, atypical CSF WBC counts were noted in immunocompromised patients with viral meningitis/encephalitis. Immunocompromised patients with viral meningitis/encephalitis had lower CSF WBC counts compared to immunocompetent patients, with a trend towards lower lymphocyte counts and greater monocyte counts in immunocompromised patients.

Immunocompromised patients have a less robust immune response to pathogens, which may make detecting a CSF signature of disease activity to particular pathogens more difficult.5 Notably, 14 cases of the viral meningitis cases had a CSF WBC count of less than five cells, a result consistent with a normal CSF profile. This was most commonly seen in immunocompromised patients infected with HHV-6 (n=10). Such atypical infectious profiles may delay appropriate workup, diagnosis, and management, suggesting the need for more tailored guidelines for immunocompromised patients. Multi-site collaboration with pooling of retrospective databases to increase generalizability of findings and validate this hypothesis is pending.

References
Spanos A et al. Differential diagnosis of acute meningitis. JAMA. 1989;262(19):2700-7. Tunkel AR et al. Infectious Diseases Society of America. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008;47(3):303-27. Fouad R et al. Role of clinical presentations and routine CSF analysis in the rapid diagnosis of acute bacterial meningitis in cases of negative gram stained smears. J Trop Med. 2014;2014:213762. Habis R et al. Absence of cerebrospinal fluid pleocytosis in encephalitis. Clin Infect Dis. 2024;ciae391. Thomas S et al. CSF Profiles of Immunocompromised Patients with Bacterial and Viral Meningitis. Poster 003. AAN Annual Meeting, April 5-9, 2025. Fodor PA et al. Atypical herpes simplex virus encephalitis diagnosed by PCR amplification of viral DNA from CSF. Neurology. 1998;51(2):554-9.

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