Spectrum: Local Antimicrobial Stewardship, for Providence Health Care

Lumbar Puncture

Instructions

Record opening pressure & CSF appearance

Send for cell count with differential, glucose, protein, gram stain and bacterial cultures

For suspected viral meningitis, add PCR for HSV 1/2, VZV and Enterovirus

For aseptic meningitis: add fungal culture, serum, CSF cryptococcal antigen, and syphilis EIA

Minimum of 5ml of CSF is required (for tube 1-3 1ml/tube, and 2ml for tube 4)

Tube 1: Chemistry
Tube 2: Micro/Virology
Tube 3: Haematology
Tube 4: Save for other studies

CSF Characteristics

Normal

Appearance: Clear
WBC: 0-5/mcgL
Predominant cell type: n/a
Protein: 0.15-0.5 g/L
Glucose: 2.5-4.5 mmol

Bacterial

Appearance: Turbid
WBC: ↑↑↑
Predominant cell type: Neutrophils
Protein: ↑↑
Glucose ↓↓

Viral

Appearance: Clear
WBC: ↑
Predominant cell type: Lymphocytes
Protein: Normal or mild elevation
Glucose ↓

Note

CSF profile may not be typical of bacterial infection in case of partially treated meningitis

Add Acyclovir if CSF profile is compatible with viral meningitis

PCR of CSF can be negative initially in the course of HSV infection. Repeat LP if clinical presentation is consistent with HSV meningoencephalitis