Bacterial meningitis lumbar puncture

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]


Lumbar puncture is the single most specific test to confirm the diagnosis of bacterial meningitis. It is indicated in all patients with suspicion of bacterial meningitis unless there is a contraindication. The CSF findings in patients with bacterial meningitis include low glucose concentration, high protein content, increased no of granulocytes and lactate levels >2.1mmol/l.[1][2]

Lumbar puncture

Indications of lumbar puncture

Lumbar puncture is indicated in all pateints with strong suspicion of meningitis for the following reasons:[3]

  • To confirm the diagnosis
  • To differentiate the different causes of meningitis
  • To diagnose the specific causative agent for bacterial meningitis
  • To start the appropriate treatment as early as possible to prevent complications

Findings of lumbar puncture in bacterial meningitis

Following CSF findings may suggest bacterial meningitis:[1][2]

  • A pressure of over 180 mmH2O [1][2][4][5]
  • CSF cell count in 1000s[2]
  • Granulocytes > lymphocytes
  • Elevated protein may range between 100-500mg/dl
  • Glucose ratio (CSF/plasma) <0.3
  • CSF lactate >2.1mmol/l[4][5]
  • CSF gram stain findings

Contraindications of lumbar puncture

Contraindications of lumbar puncture may include the following:[6][3]

  • Increased intracranial pressure
  • Mass lesion such as tumour
  • Thrombocytopenia
  • Bleeding diathesis


  1. 1.0 1.1 1.2 de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators (2002). "Dexamethasone in adults with bacterial meningitis". N Engl J Med. 347 (20): 1549–56. doi:10.1056/NEJMoa021334. PMID 12432041. Review in: ACP J Club. 2003 May-Jun;138(3):60
  2. 2.0 2.1 2.2 2.3 Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS; et al. (1993). "Acute bacterial meningitis in adults. A review of 493 episodes". N Engl J Med. 328 (1): 21–8. doi:10.1056/NEJM199301073280104. PMID 8416268.
  3. 3.0 3.1 Doherty CM, Forbes RB (2014). "Diagnostic Lumbar Puncture". Ulster Med J. 83 (2): 93–102. PMC 4113153. PMID 25075138.
  4. 4.0 4.1 Huy NT, Thao NT, Diep DT, Kikuchi M, Zamora J, Hirayama K (2010). "Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis". Crit Care. 14 (6): R240. doi:10.1186/cc9395. PMC 3220013. PMID 21194480.
  5. 5.0 5.1 Sakushima K, Hayashino Y, Kawaguchi T, Jackson JL, Fukuhara S (2011). "Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis". J Infect. 62 (4): 255–62. doi:10.1016/j.jinf.2011.02.010. PMID 21382412.
  6. Sempere AP, Berenguer-Ruiz L, Lezcano-Rodas M, Mira-Berenguer F, Waez M (2007). "[Lumbar puncture: its indications, contraindications, complications and technique]". Rev Neurol. 45 (7): 433–6. PMID 17918111.

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