Microbiology

Full details for "Cerebrospinal fluid ".

Name

Cerebrospinal fluid

Alternative name/Profile

CSF / Meningitis / encephalitis / Lumbar puncture / Neurosyphilis / Lyme disease / FilmArray / ME panel / BioFire

Department

Microbiology

Investigation

Specimen type

Cerebrospinal fluid. Blood cultures should be collected from all patients with suspected meningitis.

Sample type

Sample container & volume

THREE sequentially labelled sterile white-capped containers containing 10 drops of fluid. Please also send OCM labels for CSFGLu and CSFProt in the same bag and these will be appropriately forwarded to Biochemistry through the Microbiology department.

Frequency of analysis

As required

Turnaround time

Microscopy results available within 2 hours of receipt of specimen. Final report available within 3 days(except where extended microbiology culture is requested this will reflect on the TAT which may be longer)

Availability

Monday - Sunday

Notes

CSF should be collected from all adult patients with suspected meningitis except when a clear contraindication exists (e.g. signs of raised intra-cranial pressure, focal neurological signs, severe shock, severely depressed or fluctuating conscious level, coagulation disorder) or if there is a confident clinical diagnosis of meningococcal infection with a typical rash.

Note: Antimicrobials should NOT be withheld pending a lumbar puncture.

All CSF samples are urgently delivered, by hand , to the security desk in CPL where they are immediately announced over the loud speaker system to be collected by the Microbiology department. CSF samples requiring tests performed in other laboratories must go to Microbiolooogy first and are distributed from there.

If a spectrophotometric examination for xanthochromia is required please send a fourth specimen with a minimum of 1 mL of CSF directly to Biochemistry. The specimen container should be wrapped in tin foil to protect it from light.

*Uniform bloodstaining of all CSF samples received suggests previous haemorrhage into the sub-arachnoid space, whereas reducing counts in sequentially obtained samples suggest bleeding induced by the tap procedure. A WBC:RBC ratio of 1:500 to 1:1000 is generally regarded as not indicative of infection.

For patients with query CJD please refer to the CSF 14-3-3 (CJD) Information and fill out CJD Questionaire Form (Protein 14-3-3)

Reporting of Results:

Positive Results are notified immediately to relevant medical staff. Negative results are released for viewing on the EPR system.

FilmArray analysis is carried out at the request of the Clinical Microbiology Team.

The FilmArray Meningitis/Encephalitis (ME) Panel is a qualitative multiplexed nucleic acid-based in vitro diagnostic test.

The FilmArray ME Panel is capable of simultaneous detection and identification of multiple bacterial, viral, and yeast nucleic acids directly from cerebrospinal fluid (CSF) specimens obtained via lumbar puncture from individuals with signs and/or symptoms of meningitis and/or encephalitis.

The following organisms are identified using the FilmArray ME Panel:

Bacteria	Viruses	Fungi
Escherichia coli K1	Cytomegalovirus (CMV)	Cryptococcus neoformans/gattii
Haemophilus influenzae	Enterovirus
Listeria monocytogenes	Herpes simplex virus 1 (HSV-1)
Neisseria meningitidis	Herpes simplex virus 2 (HSV-2)
Streptococcus agalactiae	Human herpes virus 6 (HHV-6)
Streptococcus pneumoniae	Human parechovirus
	Varicella zoster virus (VZV)