Model Answers Microbiology Written examinations 2007 - RCPA

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Common CSF findings Viral Meningitis Bacterial Menignitis Cryptococcal meningitis TB meningitis Viral encephalitis Protein Glucose Cells Gm stain Bacterial culture Comments No or No Predominately Neg Neg Can do Slightly Lymphs enterovirus raised (some pdys PCR Raised Raised Raised No or raised day 1-3) Decreased May be pos, predominately pdys No or decreased Predominately lymphs Decreased Predominately lymphs No Predominately lymphs May be positive May be pos (Abs suggested) Neg Neg Can do India ink stain & CSF crypto AG Neg TB culture slow often 6-8 weeks Can do AFB often neg TB PCR or LCX Neg Neg Can do HSV PCR Bacterial antigens no longer done – poor sensitivity and specificity. Extra tests Rarely useful unless abnormal protein/glucose/cell count crytpococcal antigen India ink stain (Cryptococcus) TB PCR/LCX AFB stain – rarely positive, need a lot of cells TB culture (6-8 weeks) HSV 1 & 2 PCR Enterovirus PCR JC virus PCR Meningococcal PCR Syphilis serology e.g. RPR, PTHA
Question 11, Marker 2 Describe, with examples, the full laboratory investigation of CSF obtained by lumbar puncture. General points Emphasise how the nature and extent of testing is dictated by information about the patient: Importance of reading the history given Necessity of obtaining more history or speaking directly to the clinician, if indicated, both on receipt of specimen and when early results are available (microscopy, protein, glucose) as this may direct further investigations. Discuss the tests which are routinely performed Discuss testing which might be performed at the discretion of the microbiologist. (Perhaps discuss what testing in not indicated or is of limited benefit in some situations) Indicate how to prioritise testing when sample volume is limited. Microscopy Routine cell counts and interpretation of these Investigation of abnormal cells – eosinophils, cells with abnormal morphology Visual detection of organisms (include dark field microscopy for spirochaetes)
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