Lumbar Puncture Interpretation

Meningitis Routine Laboratory Results

Specific Markers

PCR

  • May vary from center to center, but generally will detect E. coli, H. influenzae, N. meningitidis, Listeria monocytogenes, Streptococcus agalactiae, Streptococcus pneumoniae, CMV, Enterovirus, HSV 1/2, HHV-6, Human parechovirus, VZV, and Cryptococcus neoformans/gattii

ADA (Adenosine Deaminase)

  • Sensitivity and specificity for tuberculous meningitis varies depending cutoff level, however, approaches 80% and 90% on average, respectively (1)

Cryptococcal Antigen

  • Sensitivities ~93-100%, with specificities ~93-98% for cryptococcal meningitis (2)

14-3-3 Protein

  • Sensitivity ~93%, specificity ~80% for spontaneous Creutzfeld-Jakob Disease (sCJD) (3)

Oligoclonal Bands

  • Sensitivity 75–92%, specificity 86–92%, negative predictive value 97% for Multiple Sclerosis (4)

Aβ42 Protein

  • Correlates with Alzheimer’s Disease, but no good data for sensitivity or specificity. Not recommended for routine diagnosis (5)

References

  1. Ekermans, P., Dusé, A., & George, J. (2017, January 31). The dubious value of cerebrospinal fluid adenosine deaminase measurement for the diagnosis of tuberculous meningitis. BMC Infectious Diseases. https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-017-2221-3. 
  2. Tanner DC;Weinstein MP;Fedorciw B;Joho KL;Thorpe JJ;Reller L; (n.d.). Comparison of commercial kits for detection of cryptococcal antigen. Journal of clinical microbiology. https://pubmed.ncbi.nlm.nih.gov/7929757/. 
  3. Muayqil, T., Gronseth, G., & Camicioli, R. (2012, October 2). Evidence-based guideline: diagnostic accuracy of CSF 14-3-3 protein in sporadic Creutzefldt-Jakob disease: report of guideline development subcommittee of the American Academy of Neurology. Neurology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525296/.
  4. Ferraro, D., et al (2020). Kappa Index versus CSF Oligoclonal Bands inPredicting Multiple Sclerosis andInfectious/Inflammatory CNS Disorders. Diagnostics
  5. McKhann, G. M., Knopman, D. S., Chertkow, H., Hyman, B. T., Jack, C. R., Kawas, C. H., Klunk, W. E., Koroshetz, W. J., Manly, J. J., Mayeux, R., Mohs, R. C., Morris, J. C., Rossor, M. N., Scheltens, P., Carrillo, M. C., Thies, B., Weintraub, S., & Phelps, C. H. (2011, May). The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & dementia : the journal of the Alzheimer’s Association. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312024/. 

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