Thus we say that meningococcal meningitis gives rise to increased polymorphonuclear cells and tuberculous meningitis to increased lymphocytes. This, however, seems to depend entirely on the intensity of the stimulus given by the infecting micro-organism and the stage of the disease at which the fluid is obtained. Thus if a case of meningococcal meningitis is seen early enough, before the infecting organism has multiplied
CEREBRO-SPINAL FLUID FINDINGS IN A CASE OF MENINGOCOCCAL MENINGITIS By M. G. PRADHAN, p1i.d. (Lond.), d.t.m.&h. (Eng.) Honorary Bacteriologist, Goculdas Tejpal Hospital, Bombay The examination of a sample of cerebro-spinal fluid gave the following results :? General examination (naked eye).?
Appearance Deposit Coagulnm Chemical
Absent. A fine fibrinous coagulnm present after two hours.
Total proteins Globulin
Increased (qualitative). Pandy's test?positive. Nonne-Apelt phase I?positive. Present, diminished (qualita-
tive). 730 mgm. per 100
Cytological examination.? Total number of cells. Differential count
Mononuclears?60 per cent.
examination (centrifuged Bacteriological examined stained).? No micro-organisms Gram's stain ..
Ziehl-Neelsen stain No acid-fast bacilli found even after prolonged search. (The fluid was incubated at 37?C. for 12 hours, and centrifuged deposit was again examined for micro-
Gram's stain Gram-negative diplococci present. The deposit was plated on ascitic agar and a pure culture of meningococci was obtained. ..
Levinson's differential test.? Levinson's differential precipitation test gave positive result for tuberculous meningitis.
Comments.?In the absence of a direct demonstration of the infecting micro-organism in the smears made from the centrifuged deposit of the fluid, other findings such as the number and the type of cells, presence or absence of sugar, and the quantitative estimation of chlorides help to determine the diagnosis in a case of meningitis.
in the present case, find a of predominance lymphocytes. (The fluid in the present case was obtained on the very first day when the patient complained of fever and headache). Alternatively, I have seen a pure poly* morphonuclear exudate in a case of tuberculous meningitis following acute miliary tuberculosis. Similarly the character of the coagulum also will depend upon the number of cells and the amount of fibrin present in the fluid. In this case the quantitative estimation of chlorides alone helped diagnosis, and treatment for meningococcal meningitis was instituted on the strength of the chloride finding alone, without waiting for further bacteriological examination. An examination of the patient's blood film revealed a polymorphonuclear leucocytosisSubsequently, on incubation and further cul" ture, meningococcus was obtained from the fluidThe patient also made a remarkable recovery on specific antiserum combined with M. & $? ponse,
693. Levinson's differential precipitation test was done out of academic interest and to my sui" prise it was found positive for tuberculous meningitis. The reaction is said to depend on the electrical charge of the exudate which is different for meningococcal and tuberculous meningitis which gives rise to different quantities of precipitates. Here too it may be pointed out that the electrical charge, the type, and the amoufl of precipitate will depend entirely on the typ? of cells forming the exudate. On this accoun it is suggested that the test is no more specifi0 than the differential count of the fluid.