What are the cerebrospinal fluid (CSF) glucose and protein levels in bacterial meningitis?

From the Guidelines

Bacterial meningitis is characterized by very low CSF glucose levels and raised CSF protein levels, as indicated in the 2016 UK Joint Specialist Societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults 1. In the context of bacterial meningitis, the cerebrospinal fluid (CSF) analysis is crucial for diagnosis. Key findings include:

• Very low CSF glucose levels, typically less than 2.6e4.5 mmol, which is a result of bacterial consumption of glucose in the CSF 1.
• Raised CSF protein levels, typically above 0.4 g/L, due to increased permeability of the blood-brain barrier caused by inflammation 1. These changes, along with an increased white blood cell count (predominantly neutrophils) in the CSF, help distinguish bacterial meningitis from viral or fungal causes. The 2016 guideline recommends documenting CSF glucose with concurrent plasma glucose and CSF protein in all patients undergoing a lumbar puncture (LP) for suspected meningitis or meningococcal sepsis 1. Therefore, in cases of suspected bacterial meningitis, it is essential to promptly analyze CSF glucose and protein levels, alongside other laboratory findings and clinical presentation, to guide early diagnosis and treatment with appropriate antibiotics.

From the Research

Glucose and Protein CSF Levels in Bacterial Meningitis

• The provided studies do not directly address glucose and protein CSF levels in bacterial meningitis 2, 3, 4, 5, 6.
• However, the studies discuss the treatment and management of bacterial meningitis, including pneumococcal meningitis 2, 3, 4, 5, 6.
• The studies suggest that vancomycin and a third-generation cephalosporin should be used as empiric therapy for suspected bacterial meningitis 2, 3, 6.
• The use of other antibiotics, such as meropenem and fluoroquinolones, may also be considered in certain cases 2, 3, 4.
• The evaluation and management of bacterial meningitis involve prompt recognition and treatment, as well as the use of adjuvant therapies such as corticosteroids 5.