Meningitis is defined as inflammation of the meninges. This
process may be acute or chronic and infective or non-infective.
Many infective agents have been shown to cause meningitis,
including viruses, bacteria, fungi and parasites.
Royal Manchester Children's Hopsital is a specialist paediatric
neurology centre; as such CSF obtained from ventricular shunts and
shunts removed during revision may also be submitted to the
laboratory for microscopy and culture.
Collection container (including preservatives):
Collect specimens in appropriate CE marked leak proof containers
and transport specimens in sealed plastic bags.
Specimen type: Cerebrospinal Fluid
Collection: Use aseptic technique. Collect
specimens into appropriate CE marked leak proof containers and
place in sealed plastic bag.
Specimen transport: Specimens should be
transported and processed as soon as possible.
Minimum volume of sample: For routine cell
count and culture; ideally a minimum volume of 1mL
For Mycobacteria sp., culture (Tb), at least 6mL where possible;
such investigations cannot be performed outside of normal hours
CSF is normally collected sequentially into three or more
separate containers which should be numbered consecutively.
Special precautions: Always contact the
laboratory when sending a CSF sample. Send sample 3 (or the last
sample if more than 3 taken) to Microbiology. Outside of normal
hours contact the on-call Biomedical Scientist through the main
Measurement units: Cell count
Biological reference units:
- Neonates: 0 - 30 cells x 106/L
- 1-4yr old 0 - 20 cells x 106/L
- 5yr-puberty 0 - 10 cells x 106/L
- Adults 0 - 5 cells x 106/L
When possible the WBC count will be differentiated into
lymphocytes and polymorphs.
- Newborn 0 - 675 cells x 106/L
- Adults 0 - 10 cells x 106/L
Protein (Performed by Biochemistry)
- Neonate (Up to 7 days): 0.4 to 1.1 g/L
- 1 to 4 weeks: 0.2 - 0.8 g/L
- 1 to 3 months: 0.2 - 0.7 g/L
- 3 months to adult: 0.05 - 0.45 g/L
Glucose (Performed by Biochemistry)
- 40% - 80% plasma level collected at the same time, generally
3.0 to 6.0mmol/L
Turnaround time: 30 mins to 1 hour for
microscopy. 48 hrs - 72 hrs for culture
Clinical decision points: Not applicable
Factors known to significantly affect the
results: Cells disintegrate and a delay may produce a cell
count that does not reflect the clinical situation of the