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Journal of Clinical Microbiology, June 1998, p. 1617-1620, Vol. 36, No. 6
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Microscopic Examination and Broth Culture of Cerebrospinal Fluid in Diagnosis of Meningitis

Sherry A. Dunbar,1,2 Rachel A. Eason,3 Daniel M. Musher,4,5 and Jill E. Clarridge III1,2,4,*

Department of Pathology,1 Department of Microbiology and Immunology,4 and Physician Assistant Training Program,3 Baylor College of Medicine, and Pathology and Laboratory Medicine Service2 and Medical Service, Infectious Diseases Section,5 Veterans Affairs Medical Center, Houston, Texas 77030

Received 24 November 1997/Returned for modification 20 January 1998/Accepted 17 March 1998

We reviewed the results of microscopic Gram stain examination and routine culture for 2,635 cerebrospinal fluid (CSF) samples processed in an adult hospital microbiology laboratory during 55 months. There were 56 instances of bacterial or fungal meningitis (16 associated with central nervous system [CNS] shunt infection), four infections adjacent to the subarachnoid space, four cases of sepsis without meningitis, and an additional 220 CSF specimens with positive cultures in which the organism isolated was judged to be a contaminant. Because 121 of these contaminants were isolated in broth only, elimination of the broth culture would decrease unnecessary work. However, 25% of the meningitis associated with CNS shunts would have been missed by this practice. The most common cause of meningitis was Cryptococcus neoformans, followed by Streptococcus pneumoniae and Neisseria meningitidis. In 48 of 56 (88%) of cases, examination of the Gram-stained specimen revealed the causative organism. If patients who had received effective antimicrobial therapy prior to lumbar puncture are excluded, the CSF Gram stain is 92% sensitive. Microscopic examination incorrectly suggested the presence of organisms in only 3 of 2,635 (0.1%) CSF examinations. Thus, microscopic examination of Gram-stained, concentrated CSF is highly sensitive and specific in early diagnosis of bacterial or fungal meningitis.

* Corresponding author. Mailing address: Pathology and Laboratory Medicine Service (113), Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030. Phone: (713) 794-7336. Fax: (713) 794-7657. E-mail: jillc{at}bcm.tmc.edu.

Journal of Clinical Microbiology, June 1998, p. 1617-1620, Vol. 36, No. 6
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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