Spectrum of cerebrospinal fluid analysis and nervous system diseases in hospitalised patients: a hospital based prospective study from a hilly state of Himachal Pradesh in North India


  • Laxmi Nand Department of Medicine, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
  • Prem S. Chauhan Department of Medicine, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
  • Sudhir Sharma Department of Neurology, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
  • Rakesh Shandil Department of Medicine, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India




Adenosine deaminase, Cerebrospinal fluid, Meningitis, Sensitivity and specificity


Background: The cerebrospinal fluid (CSF) analysis is an invaluable diagnostic aid in various nervous system diseases.  Many times, alterations in normal CSF parameters with variable and overlapping results are challenging in differential diagnosis and treatment of the diseases. The aim of the study is to know the spectrum of CSF analysis and nervous system diseases with different prevalence in our setup.

Methods: Total 150 hospitalised patients with various nervous system diseases and indications were subjected to lumbar puncture and the CSF analysis was done, in a period of one year study.

Results: A total of 150 patients with mean age of 50.41±19.54 years had male to female ratio of 1.63:1. CSF analysis revealed most of tuberculous meningitis (TBM) in 30(20%) patients with higher adenosine deaminase (ADA) levels of 10.7±20.24 IU/L and lymphocytic leukocytosis (81.93%). Bacterial meningitis in 8(5.3%) patients revealed highest increase in CSF mean protein levels of 349.63±226.39 mg/dL and in mean cell count of 1039.50±930.23 cells/mm3. There was significant increase in protein levels and decrease in glucose levels of CSF, both in TBM and bacterial meningitis compared to viral, fungal meningitis and other central nervous system (CNS) diseases(p<0.001).

Conclusions: Spectrum of CSF analysis and CNS diseases revealed consistent findings of alteration of normal CSF variables and therefore, was found as an invaluable, rapid and cost-effective differentiating diagnostic tool.


McGing, O’ Kelly R, editors. The biochemistry of body fluid. Ireland: The Scientific Committee of the Association of Clinical Biochemists in Ireland (ACBI);2009.

Hajdu S. Discovery of the cerebrospinal fluid. Annal Clin Lab Sci. 2003;33:3.

Steele RW, Marmer DJ, O’Brien MD, Tyson ST, Steele CR. Leucocyte survival in CSF. J Clin Microbiol. 1986;23(5):965-6.

Seehusen DA, Reeves MM, Fomin DA. Cerebrospinal fluid analysis. Am Fam Physician. 2003;68(6):1103-09.

Deisenhammer F, Bartos A, Egg R, Gilhus NE, Giovannoni G, Sellebjerg F, et al. Routine cerebrospinal fluid (CSF) analysis. In: Gilhus NE, Barnes MP, Brainin M, eds. European Handbook of Neurological Management. 2nd ed. Blackwell Publishing Ltd; 2011:5-18.

Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev. 2010;23(3):467-92.

Gray LD, Fedorko DP. Laboratory diagnosis of bacterial meningitis. Clin Microbiol Rev. 1992;5(20):130-45.

Klein NC, Damsker B, Hirschman SZ. Mycobacterial meningitis. Am J Med. 1985;79:29-34.

Hosoglu S, Ayaz C, Geyik MF, Kokoglu OF, Ceviz A. Tuberculous meningitis in adults. Int J Tuberc Lung Dis. 1998;2(7):553-7.

Kelly JJ, Horowitz EA, Destache CJ, Fruin AH, Long VA. Diagnosis and treatment of complicated tubercular meningitis. Pharmacother: J Human Pharmacol Drug Ther. 1999 Oct;19(10):1167-72.

Baheti R, Laddha P, Gehlot R. CSF- Adenosine deaminase (ADA) activity in various type of meningitis. J Indian Acad Clin Med. 2001;2(4):285-7.

Solari L, Soto A, Agapito JC, Acurio V, Vargas D, Battaglidi T, et al. The validity of cerebrospinal fluid parameters for the diagnosis of tuberculous meningitis. Int J Infect Dis. 2013;17(12):1111-5.

Gupta BK, Bharat A, Debapriya B, Baruh H. Adenosine deaminase levels in CSF of tuberculous meningitis patients. J Clin Med Res. 2010;2(5):220-4.

Fouad R, Khairy M, Fathalah W, Gad T, El-Kholy B, Yosry A. Role of clinical presentations and routine CSF analysis in the rapid diagnosis of acute bacterial meningitis in cases of negative gram stained smears. J Trop Med. 2014;21:376-82.

JamaiyarA, Shrivastava KR. Cytological analysis of CSF as cost effective tool in early cases of meningitis. IOSR J Dent Med Sci (IOSR-JDMS). 2017;16:06-08.

Pandey P, Jha B, Shrestha A. Cytological and biochemical profile of cerebrospinal fluid from meningitis patients. ACCLM. 2015;1(1):2-5.

Rekha P, Sarada U, Venkateswarlu U, Reddi P. Study of biochemical profile in viral meningitis. IOSR J Dent Med Sci (IOSR-JDMS). 2015;14(3): 45-7.

Mahdawi MA, Jabar B, Mahmood E, Hatem A, Jalal M. Detection of herpes simplex viruses I and II in cerebrospinal fluid specimens of Iraqi children presenting with aseptic meningitis by using real time PCR assay. IOSR J Dent Med Sci (IOSR-JDMS). 2016;15(12):75-8.

Annual Status Report. Revised National Tuberculosis Control Programme. Chapter 2, TB Disease Burden in India. TB India 2017. Available in: http://tbcindia.gov.in/WriteReadData/TB%20India%202017.pdf. Accessed 24 Mar, 2017.

Vasanthan K, Verghese Y, Singh RBS, Damodharan J, Vengadakrishnan K. Profile of cerebrospinal fluid analysis in acute central nervous system infections. Int J Sci Stud. 2018;6(1):99-103.

Agarwal AK, Bansal S, Nand V. A hospital based study on estimation of adenosine deaminase activity (ADA) in cerebrospinal fluid (CSF) in various types of meningitis. J Clin Diag Res. 2014;8(2):73-6.

Jain S, Sharma A, Nayak R. Diagnostic role of CSF-ADA in differential diagnosis of meningitis. Int J Cont Med Res. 2016;3(8):2201-03.

Moghtaderi A, Alavi-Naini R, Izadi S, Cuevas LE. Diagnostic risk factors to differentiate tuberculous and acute bacterial meningitis. Scand J Infect Dis. 2009;41:188-94.

Wani AM, Hussain WM, Fatani M, Shakour BA. Clinical profile of tuberculous meningitis in Kashmir valley the Indian subcontinent. Infect Dis Clin Pract. 2008;16:360-7.

Thwaites GE, Chau TT, Stepniewska K, Phu NH, Chuong LV, Sinh DX, et al. Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features. Lancet. 2002;360:1287-92.

Chotmongkol V, Teerajetgul GY, Yodwut C. Cerebrospinal fluid adenosine deaminase activity for the diagnosis of tubercular meningitis in adults. Southeast Asia J Trop Med Public Health. 2006;37:948-52.

Singh A, Shukla AK, Kaur R, Kajal NC, Nadia, Kaur L, Neki NS. Role of CBNAAT in diagnosis of tuberculous meningitis. Int J Curr Res Med Sci. 2018;4(2): 59- 65.

Denkinger CM, Schumacher SG, Boehme CC, Dendukuri N, Pai M, Steingart KR. Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis. Eur Res J. 2014;44(2):435-46.

Abro AH, Abdou AS, Ali H, Ustadi AM, Hasab AAH. Cerebrospinal fluid analysis-acute bacterial versus viral meningitis. Pak J Med Sci. 2008; 24(5): 645-50.

Satishchandra P, Mathew T, Gadre G, Nagarathna S, Chandramukhi A, Mahadevan A, et al. Cryptoccocal meningitis: clinical, diagnostic and therapeutic overviews. Neurol India. 2007;55:226-32.

Karande S. Gupta V, Kurkarni M, Joshi A. Prognostic clinical variables in childhood tuberculous meningitis: an experience from Mumbai, India. Neurol India. 2005;53(2):191.






Original Research Articles