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How and when to use CSF to investigate neonates and children with possible central nervous system infection
  1. Gemma Winzor1,2,
  2. Sowsan F Atabani1,2
  1. 1 Birmingham Public Health laboratory, National Infection Service, Public Health England Midlands and East Region, Birmingham, UK
  2. 2 Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Gemma Winzor, Public Health England Midlands and East Region, Birmingham, Birmingham, UK; g.winzor{at}


A child presented to the emergency department with fever, reduced consciousness, irritability and reduced oral intake. Infective meningitis and encephalitis were within the differential diagnoses. Is a lumbar puncture (LP) indicated and, if so, what is the optimal timing of LP? Will antimicrobial pretreatment affect the cerebrospinal fluid (CSF) results? How can clinicians optimise diagnostic stewardship to benefit individual patients and society at large? Interpretation of rapidly available CSF biochemical tests (protein, glucose and lactate levels) and microscopy can provide a prompt insight into the infective aetiology and inform treatment and further diagnostic testing strategies. Diagnosis of an aetiological pathogen in a patient presenting with central nervous system (CNS) infection has clinical, infection control and public health implications. A plethora of tests are available to enable CSF analysis in patients with possible CNS infection. We aimed to summarise current evidence and guidance to ensure the best possible use of the diagnostics available.

  • microbiology
  • virology

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  • Contributors GW conceptualised the paper, approached the editorial team, drafted the submission proposal, and researched, wrote and edited the paper. SFA conceptualised, researched, wrote and edited paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.