Polymorphonuclear Cells (CSF)
Polymorphonuclear Cells (PMNs) in Cerebrospinal Fluid (CSF)
Polymorphonuclear cells (PMNs), primarily neutrophils, are a type of white blood cell crucial in the body's immune response to bacterial infections. Their presence in cerebrospinal fluid (CSF) often indicates inflammation or infection affecting the central nervous system (CNS).
Normal Levels of PMNs in CSF
In healthy individuals, CSF typically contains 0-5 PMNs/µL. The blood-brain barrier normally restricts immune cells from entering the CNS unless there's an abnormality.
What Elevated PMNs in CSF Mean
An increased percentage of PMNs in CSF, known as neutrophilic pleocytosis, typically indicates an acute inflammatory or infectious process in the CNS. Common causes include:
- Bacterial Meningitis:
- Hallmark: PMN predominance in CSF (often >80% of total white blood cells)
- Associated findings: Elevated CSF protein, decreased glucose levels, positive bacterial cultures
- PMN count can exceed 1,000 cells/µL in severe cases
- Early Viral Meningitis or Encephalitis:
- PMNs may appear transiently before lymphocytes dominate
- Usually lower PMN counts compared to bacterial meningitis
- CNS Abscesses or Empyema:
- Localized infections leading to PMN infiltration
- Often accompanied by fever and focal neurological signs
- Trauma or Surgery:
- CNS disruption may cause increased PMNs due to inflammation or secondary infection
- Can persist for several days post-event
- Fungal or Tubercular Meningitis:
- Typically cause lymphocytic pleocytosis, but PMNs may appear in mixed infections or early disease stages
- Subarachnoid Hemorrhage (SAH):
- PMNs increase as part of the inflammatory response to blood in the subarachnoid space
- Usually accompanied by xanthochromia in CSF
Clinical Implications
PMNs in CSF are crucial for identifying acute CNS infections, particularly in distinguishing bacterial from viral meningitis. The degree of PMN elevation, along with other CSF parameters (glucose, protein, cell counts), helps determine the likelihood of bacterial infection.
Interpretation Considerations
- Timing of lumbar puncture is crucial; very early in the course of meningitis, PMN counts may be deceptively low
- In partially treated bacterial meningitis, PMN counts might be lower than expected
- Repeated lumbar punctures may be necessary to track the progression of CSF findings
Next Steps
If PMNs are found in CSF, immediate consultation with a healthcare provider is essential. Further investigations, including CSF culture, PCR for pathogens, and neuroimaging, may be necessary. Prompt diagnosis and treatment are critical, especially for potentially life-threatening conditions like bacterial meningitis.
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