title: Hypoglycorrhachia in adults with community-acquired meningitis: etiologies and prognostic significance.
abstract: OBJECTIVE
  Hypoglycorrhachia (cerebrospinal fluid (CSF) glucose <45 mg/dl) has been identified as a prognostic factor in patients with meningitis. The differential diagnosis of hypoglycorrhachia and its clinical significance was analyzed in the present study.
  
  
  METHODS
  This was a retrospective study of 620 adult patients with community-acquired meningitis (CSF white blood cell count >5 × 10(6) cells/l and absence of a CSF shunt or recent neurosurgical procedure (<1 month)) at eight Memorial Hermann hospitals in Houston, Texas, from January 2005 to December 2010. An adverse clinical outcome was defined as a Glasgow outcome scale score of ≤ 4.
  
  
  RESULTS
  Out of 620 patients with meningitis, 116 (19%) had hypoglycorrhachia. Etiologies of hypoglycorrhachia were idiopathic (n=40), bacterial (n=27), cryptococcal (n=26), viral (n=15), and tuberculous (n=4). Patients with hypoglycorrhachia were more likely to be immunosuppressed, have a history of intravenous drug use, and present with a vesicular or petechial rash, nausea or vomiting, nuchal rigidity, sinusitis/otitis, abnormal mental status, and focal neurological deficits compared to those patients without hypoglycorrhachia (p<0.05). Additionally, patients in the hypoglycorrhachia group had significantly higher rates of positive CSF and blood cultures, urgent treatable conditions, and abnormal cranial imaging (p<0.05). Furthermore, patients with hypoglycorrhachia had more adverse clinical outcomes (26/116 (22.4%) vs. 45/504 (8.9%); p<0.001).
  
  
  CONCLUSIONS
  Hypoglycorrhachia has significant clinical and prognostic value in the evaluation of adult patients with community-acquired meningitis.
authors: Department of Internal Medicine, University of Texas Health Science Center, 6431 Fannin St., 2.112 MSB, Houston, TX 77030, USA.
authors: Vandana
authors: V
authors: Shrikanth
authors: Department of Internal Medicine, University of Texas Health Science Center, 6431 Fannin St., 2.112 MSB, Houston, TX 77030, USA.
authors: Lucrecia
authors: L
authors: Salazar
authors: Department of Internal Medicine, University of Texas Health Science Center, 6431 Fannin St., 2.112 MSB, Houston, TX 77030, USA.
authors: Nabil
authors: N
authors: Khoury
authors: Department of Pediatrics, University of Texas Health Science Center, Houston, Texas, USA.
authors: Susan
authors: S
authors: Wootton
authors: Department of Internal Medicine, University of Texas Health Science Center, 6431 Fannin St., 2.112 MSB, Houston, TX 77030, USA. Electronic address: Rodrigo.Hasbun@uth.tmc.edu.
authors: Rodrigo
authors: R
authors: Hasbun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid*; D006801:Humans; D008297:Male; D008581:Meningitis / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D005947:Glucose
keywords: Hypoglycorrhachia; Meningitis; Prognosis