CSF in acute and chronic infectious diseases

Abstract

Infections of the nervous system are an important and challenging aspect of clinical neurology. Immediate correct diagnosis enables to introduce effective therapy, in conditions that without diagnosis may leave the patient with severe neurological incapacitation and sometimes even death. The cerebrospinal fluid (CSF) is a mirror that reflects nervous system pathology and can promote early diagnosis and therapy. The present chapter focuses on the CSF findings in neuro-infections, mainly viral and bacterial. Opening pressure, protein and glucose levels, presence of cells and type of the cellular reaction should be monitored. Other tests can also shed light on the causative agent: serology, culture, staining, molecular techniques such as polymerase chain reaction. Specific examination such as panbacterial and panfungal examinations should be examined when relevant. Our chapter is a guide-text that combines clinical presentation and course with CSF findings as a usuaful tool in diagnosis of neuroinfections. ACUTE INFECTIOUS DISEASES OF THE NERVOUS SYSTEMAcute infections of the nervous system are as diverse in their clinical consequences for the patient as the variety of infectious agents causing them: from mild headaches to long-term morbidity and a threat to life. Therefore, the earliest possible diagnosis is absolutely essential. Central here stands the examination of the CSF. The correct diagnosis is often dependent on this rather simple procedure to allow diagnosis and focused antimicrobial and adjunctive therapy. This chapter deals with acute infectious diseases of the nervous system and the importance of the lumbar puncture (LP) in the diagnostic process.

Elevated Free Phosphatidylcholine Levels in Cerebrospinal Fluid Distinguish Bacterial from Viral CNS Infections

“…This is quite different in viral CNS infections: neuroinflammation tends to be less pronounced, many cases do not require hospitalization, severe disease occurs much less frequently, and serious sequelae are less common [ 4 , 5 , 6 ]. The timely diagnosis of bacterial meningitis is imperative not only to institute antibiotic treatment as soon as possible [ 1 ], but also to arrange for other indicated diagnostic and therapeutic measures in a timely manner, and to avoid unnecessary use of antiviral or antifungal drugs [ 7 , 8 , 9 ]. In spite of advances in microbial diagnostics, the causative pathogen is still not identified in all patients.…”

Disentangling etiologies of CNS infections in Singapore using multiple correspondence analysis and random forest

“…A second major issue in the management of CNS infection is prognostication and resource allocation to manage patients. While viral meningitis generally has a good prognosis 34 , acute bacterial meningitis or viral encephalitis tend to be more severe and can be fatal 18 . Therefore, recognizing the clinical syndrome and the etiology is crucial to optimize clinical care and improve patient management.…”

“…The diagnosis of CNS infection is notoriously difficult, and early treatment is often empirical. Timely identification of the etiologic agent is crucial to optimize clinical care, as disease outcome often depends on tailoring treatment for the infectious agent 18 . This challenge is compounded by (1) the limited accessibility of the tissue where pathogen replication occurs, (2) the absence, in most clinical laboratories, of sensitive methods for molecular and serological detection of infection and (3) the lack of consensus on case definitions and standardized diagnostic approaches 19 .…”

Hydrogen Ion Dynamics as the Fundamental Link between Neurodegenerative Diseases and Cancer: Its Application to the Therapeutics of Neurodegenerative Diseases with Special Emphasis on Multiple Sclerosis

“…Moreover, bacterial meningitis induces neuroinflammation and neuronal damage through the release of reactive oxidative species and nitric oxide. This favors the onset of HNDDs, such as dementia [ 222 , 223 , 224 ], which can also be accompanied by elevations of LA [ 225 , 226 ]. Despite the unknown origin of these metabolic abnormalities, LA has been considered a biomarker of mitochondrial deregulation and a worsening agent in neuroinflammation [ 227 , 228 , 229 , 230 , 231 , 232 , 233 , 234 ].…”