From the Guidelines
A CSF neutrophil count of 26 is indicative of bacterial meningitis, as it suggests an acute inflammatory response in the central nervous system, with neutrophils being the primary responders to bacterial infections. This finding is supported by the UK Joint Specialist Societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults, which states that a raised CSF white cell count (WCC) with a predominance of neutrophils is characteristic of bacterial meningitis 1. According to the guideline, a CSF WCC of typically greater than 100 cells/μL with neutrophil predominance is seen in bacterial meningitis, and while 26 cells/μL is lower than this, the presence of neutrophils still points towards a bacterial etiology.
Key characteristics of bacterial meningitis include:
- Raised CSF WCC, typically greater than 100 cells/μL, with neutrophil predominance
- Elevated CSF protein
- Decreased CSF glucose
- Presence of neutrophils in the CSF, which is a key indicator of bacterial infection, as seen in this case with 26 neutrophils
- Clinical symptoms such as fever, headache, neck stiffness, and altered mental status
It's essential to interpret this elevated neutrophil count alongside other CSF parameters and clinical symptoms to confirm the diagnosis of bacterial meningitis. The guideline also notes that CSF culture is the gold standard for diagnosis, but it may be affected by prior antibiotic use, and CSF analysis may still be helpful up to 48 hours after commencing parenteral antibiotics 1.
In clinical practice, a CSF neutrophil count of 26 would prompt immediate further investigation and treatment for bacterial meningitis, including antibiotic therapy, as the condition requires prompt intervention to prevent serious morbidity and mortality.
From the Research
CSF Neutrophils
- The provided studies do not directly address the topic of CSF neutrophils 26 being indicative of a specific condition.
- The studies primarily focus on the treatment of bacterial meningitis, particularly pneumococcal meningitis, and the use of vancomycin and other antibiotics in such cases 2, 3, 4, 5, 6.
- There is no mention of CSF neutrophil counts or their significance in the context of bacterial meningitis in the provided studies.
- Therefore, there is no evidence to suggest what CSF neutrophils 26 may be indicative of based on the provided research papers.