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Send Core CSF Tests First
- Send a core CSF panel: cell count with differential, Gram stain, and culture as the minimum essential tests.
- These basic CSF results will drive early management more than many advanced markers.
PCR Panels Are Helpful But Not Foolproof
- Multiplex PCR meningitis/encephalitis panels are useful for detecting common viral and atypical causes when initial CSF tests are nondiagnostic.
- Their sensitivity is best for the major bacteria (Strep pneumo, Neisseria, H flu); added targets are helpful but interpret cautiously.
CSF Cell Count Drives Differential
- CSF white cell count magnitude is highly informative: any CSF WBC >5 should raise concern and higher counts push toward typical bacterial causes.
- Neutrophilic predominance with high WBC favors classic bacterial pathogens (S. pneumoniae, N. meningitidis, H. influenzae).