Program Schedule

The Clinical Significance of Cerebrospinal Fluid Neutrophilic Pleocytosis in Viral Central Nervous System Infections

Session: Poster Abstract Session: CNS Infections: Diagnostic Tools and Outcome Predictors
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • ID Week 2014 poster Final.pdf (101.8 kB)
  • Background: Viral meningitis and encephalitis is typically characterized by a cerebrospinal fluid (CSF) lymphocytic pleocytosis.  A CSF neutrophilic pleocytosis presentation has been described but its prognostic and clinical significance is unknown.  The objectives of our study were to compare the clinical and laboratory characteristics of viral central nervous system (CNS) infections with CSF neutrophilic to lymphocytic predominance and to evaluate factors associated with adverse clinical outcomes (ACO).

    Methods: We conducted a retrospective study of 182 patients with confirmed viral CNS infections from Houston, TX and New Orleans, LA from 1999 to 2013.  The patients were divided into CSF neutrophilic pleocytosis (neutrophils >50%) (n=45) and CSF lymphocytic pleocytosis (lymphocytes + monocytes >50%) (n=137).  We compared the clinical characteristics, laboratory findings, imaging results and clinical outcomes between two groups.  An adverse clinical outcome was defined as a Glasgow outcome scale 1-4. 

    Results: Of the 182 patients, 45 (25%) patients had CSF neutrophilic pleocytosis.  CSF neutrophilic predominance was more frequently seen in patients with enteroviral infection (64% vrs 33%; p<0.001) and less commonly in herpetic infections (20% vrs 46%; p=0.003).  The CSF neutrophilic pleocytosis group also presented more commonly in younger patients (p=0.001) with more respiratory symptoms (P=0.04) and had higher CSF WBC (p=0.004).  An adverse clinical outcome was presented in 29 patients (16%).  Factors associated with ACO included arboviral infection, Caucasian race, Charlson comorbidity index≥1, Age≥60, fever, focal neurological deficit, altered mental status, encephalitis, and abnormal MRI (p<0.05). 

    Conclusion: CSF neutrophilic pleocytosis occurs in 25% of patients with confirmed viral CNS infections and is most likely seen in younger patients with enteroviral infections and is associated with higher CSF pleocytosis but is not associated with higher adverse clinical outcome.

    Siraya Jaijakul, MD, Infectious Diseases, University of Texas Health Science Center at Houston, Houston, TX, Lucrecia Salazar, MD, Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, TX and Rodrigo Hasbun, MD, MPH, The University of Texas Health Science Center at Houston, Houston, TX


    S. Jaijakul, None

    L. Salazar, None

    R. Hasbun, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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