Does Absence of Pleocytosis in Cerebrospinal Fluid Exclude an Infectious Cause of Encephalitis?

Maybe not: In a large cohort of patients with infectious causes of encephalitis, almost one in five didn't have CSF pleocytosis.

Diagnosing encephalitis can be difficult, but for viral causes with specific treatments — most commonly herpes simplex virus (HSV) — early initiation of acyclovir optimizes outcomes. Now, investigators have analyzed the diagnostic value and outcomes of cerebrospinal fluid (CSF) pleocytosis (defined as ≥5 white blood cells/mm³) in patients meeting diagnostic criteria for encephalitis.

Among 597 patients with encephalitis but without clinical meningitis, 75% had CSF pleocytosis and 25% did not. In the 247 patients with an infectious cause, 19% did not have CSF pleocytosis — and in the subset of 76 with HSV encephalitis, 24% lacked CSF pleocytosis. Patients with CSF pleocytosis were more likely to have fever or headache and to receive acyclovir…

Reviewing Author

Daniel Kaul, MD

Disclosures

Grant/Research SupportNobelpharma; Pfizer

Leadership Positions in Professional SocietiesAmerican Society of Transplantation (Program Committee)

Daniel Kaul, MD

Disclosures

Grant/Research SupportNobelpharma; Pfizer

Leadership Positions in Professional SocietiesAmerican Society of Transplantation (Program Committee)

Does Absence of Pleocytosis in Cerebrospinal Fluid Exclude an Infectious Cause of Encephalitis?

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Reviewing Author