What is the significance of 26 nucleated cells in cerebrospinal fluid (CSF)?

From the Guidelines

The presence of 26 nucleated cells in cerebrospinal fluid (CSF) is indicative of an inflammatory process within the central nervous system, and further evaluation is necessary to determine the underlying cause, which could be bacterial meningitis, viral meningitis, fungal infection, or other conditions 1. The normal range for CSF white cell count (WCC) is less than 5 cells per microliter, and an elevated count suggests inflammation or infection.

• The type of cells present in the CSF can help differentiate between various conditions, with neutrophils often indicating bacterial meningitis, and lymphocytes suggesting viral or fungal infections 1.
• Additional CSF analysis, including protein levels, glucose, culture, and cell differential, is essential for proper diagnosis.
• The patient's symptoms, other laboratory findings, and clinical presentation must be correlated with the CSF results to determine the underlying cause of the elevated cell count.
• Prompt medical attention is necessary, as some causes of elevated CSF cell counts, particularly bacterial meningitis, require urgent treatment with appropriate antibiotics to prevent serious complications 1. The diagnosis of the underlying condition can be supported by the detection of specific antibodies or nucleic acid amplification tests, such as PCR, which can help identify the causative pathogen 1.
• However, a negative test result does not necessarily exclude the diagnosis, and clinical correlation is essential.
• The management of the patient should be guided by the most recent and highest-quality evidence, and treatment should be tailored to the specific underlying condition.

From the Research

Cerebral Spinal Fluid Analysis

• The presence of 26 nucleated cells in cerebral spinal fluid (CSF) can be an indicator of various conditions, including infection, inflammation, or malignancy in the central nervous system (CNS) 2.
• CSF analysis is a crucial diagnostic tool for detecting abnormalities in the CNS, and the number of nucleated cells can provide valuable information about the underlying condition.
• However, the provided studies do not directly address the specific meaning of 26 nucleated cells in CSF, as they focus on vancomycin concentrations and CSF parameters in different contexts.

Vancomycin Concentrations in CSF

• Studies have shown that vancomycin concentrations in CSF can vary widely, ranging from < 0.24 to > 100 mg/L, with an average level of 14.40 mg/L 3.
• The administration method of vancomycin, such as intravenous, intrathecal, or intraventricular, can affect CSF vancomycin concentrations, with local administration resulting in higher concentrations 3, 4.
• The penetration of vancomycin into CSF is not universally low, as previously believed, and can vary depending on the patient's condition and the administration method 5.

CSF Parameters and Barrier Function

• The CSF space is separated from the vascular system by the blood-CSF barrier (BCB), which regulates the transport of molecules across the barrier 6.
• The composition of CSF can vary due to several influencing factors, including site of production, site of sampling, CSF flow rate, and molecular size of blood-derived proteins 6.
• Alterations in lumbar CSF are mainly influenced by processes of the CNS located adjacent to the ventricular and spinal CSF space 6.