Hypoglycorrhachia and Raised Total Protein Level in CSF, as Predictive Marker for Bacterial Meningitis

Abstract

Meningitis is an inflammatory condition in which protective layer of brain and spinal cord called meninges get inflamed. Among infectious meningitis, bacterial meningitis has higher morbidity and mortality rate, the aim of current study is to evaluate predictive marker of bacterial meningitis to initiate antibiotic therapy. Current study was conducted at department of central pathology, Allama Iqbal Teaching Hospital, Dera ghazi khan. The research was carried out on total of 188 CSF samples received from different wards of above mention hospital from September 2024 to September 2025. For the measurement of CSF glucose and total protein, Cobas pure 6000 fully automation biochemistry analyzer was used. For bacterial cultivation, samples were sent to Pak city diagnostic center located in Dera ghazi khan. Among these 188 specimens, 25(13.29%) samples met exclusion criteria. From remaining 163 samples, 91(55.8%) were diagnosed with meningitis against previously set criteria of cerebrospinal fluid cell count >5/uL. Biochemical analysis reveals that out of 91 sample, 32(35.16%) were diagnosed with hypoglycorrhachia (CSF glucose level <45mg/dl) and significantly raised CSF total protein level. The mean glucose level in these thirty-two specimens was 33 mg/dL and mean total protein level was recorded 218 mg/dL. Considering these abnormal parameters as an indication of bacterial meningitis, the sample with hypoglycorrhachia and elevated protein level were sent to microbiological laboratory for bacterial culture. Among these 32 samples, 26(81.25%) cultures were found positive for bacterial growth. Significantly reduction in CSF glucose level and elevation of CSF total protein are predictive marker for bacterial meningitis and antibiotic therapy can be initiated on the basis of these parameters.