Spike's Spinal Fluid Case Flashcards
What are 3 type of CSF specimens an MD can collect?
lumbar region (spinal tap), subdural (for abscesses in brain), and ventricular aspiration
List Anatomy of skull starting with the outer—->inner
skull, dura matar, arachnoid, subarachnoid space, pia mater, csf
Normal value for WBCs in CSF
ZERO
normal value for glucose in CSF
40-80
normal value for protein in CSF
15-45
Bacterial Meningitis
-WBCs, glucose, and protein
Neutrophils, decreased, increased, and cloudy
Fungal Meningitis
-WBCs, glucose, protein
Lymphs or Monos, glucose decreased to normal, protein increased to normal
TB Meningitis
-WBCs, glucose, protein
Lymphs, glucose decreased, protein increased
Viral Meningitis
-WBCs, glucose, protein
Lymphs, glucose normal, protein normal
How do we route CSF tubes in the lab?
1 Chemistry, #2 Micro, #3 Heme
Why does hematology get tube #3?
Possibility of being a bloody tap which would clear by tube 3
If you have >1mL of CSF what should you do?
centrifuge and then resuspend pellet before plating
what plates are set up on CSF?
SBA, CHOC, and THIO
What does THIO grow?
grows anaerobes and detects small amount of organisms
What do you incubate CSF plates at?
in CO2 at 37’C
When do you plate CSF on an anaerobe plate?
if it is a brain abscess
How many slides do you set up for CSF?
2! Gram stain them one at a time and have someone else look at the other one to confirm. THEN CALL MD!
What happens if you have a positive CSF?
Have another tech gram stain and read the second slide, call MD, and then set up plates, biochemicals, and susceptibilities
If you only have 1 drop of CSF what do you do?
Put it on a CHOC plate
What are common pathogens in neonates?
Gp B Strep, Listeria, and E.coli
What are common pathogens in infants?
Haemophilus, S. pneumo, and N. meningitidis
What are common pathogens in young adults?
N. meningitidis
What are common pathogens in older adults?
S. pneumo, N. meningitidis, and Listeria
What are common pathogens in Immunocompromised patients?
Anything listed previously plus fungi and Nocardia
What are common pathogens in brain abscesses?
anaerobes-mostly from oral flora
Symptoms of meningitis
fever, headache, mental changes, photophobia, vomiting, poor feeding in infants, irritability, restlessness, coma—>death
What is common in acute meningitis?
Bacteria
What is common in chronic meningitis?
viral
What is common in chronic meningitis?
Fungal/High mortality
What is common in asceptic meningitis?
often times viral or fungal but do not detect because some labs don’t culture for these organisms
Definition of encephalitis
inflammation of brain tissue
Definition of meningocephalitis
inflammation of meninges and of brain tissue
Describe Kernig
Lay flat, flex hips, and try to straighten leg. very painful in meningitis
Describe Brudzinski
Flex head, if legs bend to compensate then likely meningitis
When do you use acridine orange stain?
If increased WBCs and can’t tell if bacteria are there, this stain will cause them to fluoresce
How is CSF stored?
always keep at RT, never refrigerate
Most common bacteria involved in brain abscesses?
Mouth flora and anaerobes
Most common bacteria involved in shunt infections?
skin flora, P. acnes
