Abstract Details

Title Impact of Immune Status on CSF Profiles in Confirmed Viral, Bacterial, and Fungal Meningitis/Encephalitis

Topic Infectious Disease

Presentation(s) P5 - Poster Session 5 (11:45 AM-12:45 PM)

Poster/Presentation
Number 3-014

Objective

Characterize cerebrospinal fluid (CSF) profiles of immunocompetent versus immunocompromised adults with confirmed infectious meningitis/encephalitis and identify predictors of CSF profiles.

Background Immunocompromise impacts the inflammatory response and infectious disease presentations. Widely accepted CSF values often guide the management of meningitis/encephalitis despite atypical profiles having been described. It is unclear to what extent immune status impacts CSF profiles in infectious meningitis/encephalitis.

Design/Methods Adults (≥18 years) admitted between 2010–2021 with bacterial, fungal, or viral meningitis/encephalitis (by ICD-9/10 codes) were identified retrospectively and confirmed by CSF DNA/RNA pathogen testing or culture. Immunocompromised status included HIV/AIDS, active malignancy or chemotherapy, organ/marrow transplantation, chronic corticosteroid/immunosuppressants, congenital immunodeficiency, or asplenia. Linear regression examined immunocompromise, age, sex, and antimicrobial exposure before lumbar puncture(LP) as predictors of CSF profiles. Mann–Whitney U tests with bootstrapped 95% confidence intervals compared groups.

Results

In viral cases (N=85), immunocompromise predicted lower CSF white blood cell counts (WBC) (ß=-1.43, p<0.0001); older age, male sex, and antimicrobial exposure prior to LP also predicted lower CSF WBC (p<0.05). Immunocompromised patients (N=21) had significantly lower CSF WBC (median[95%CI], 33 cells/µL [18-97] vs 185 [127-263]) and protein (64 mg/dL [ 53- 86] vs 93.5 [,86-105]), p<0.05.

In fungal cases(N=54), immunocompromise significantly predicted lower CSF protein (ß=-0.56,p<0.05). Immunocompromised patients (N=23) had significantly lower CSF WBC (median[95%CI], 39 cells/µL [13-68] vs 136 [76-243]) and protein (78 mg/dL [61-98] vs 119 mg/dl [96-166]), p<0.05.

In bacterial cases (N=52), there were no significant predictors of CSF profiles.

Conclusions

Immunocompromise was associated with lower CSF WBC and protein levels in viral and fungal but not bacterial meningitis/encephalitis, and should be considered when interpreting CSF profiles.

Authors/Disclosures
Sarah R. Thomas, MD PRESENTER	Ms. Thomas has nothing to disclose.
Kailyn Hayes	Miss Hayes has nothing to disclose.
Zi Ling Huang, MD	Dr. Huang has nothing to disclose.
Hai Ethan Hoang, MD (Weill Cornell Medicine)	Dr. Hoang has nothing to disclose.
Kiran Thakur, MD, FAAN (Columbia University College of Physicians and Surgeons)	Dr. Thakur has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Delve Bio.
Rachelle Dugue, MD, PhD	Dr. Dugue has nothing to disclose.

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