Journal of NeuroVirology

, Volume 25, Issue 4, pp 448–456 | Cite as

Infectious causes and outcomes in patients presenting with cerebral spinal fluid pleocytosis

  • Bethany L. Brown
  • Andrea Fidell
  • Gregory Ingolia
  • Eias Murad
  • J. David BeckhamEmail author


To evaluate the infectious etiologies, clinical features, and outcomes of patients with CNS infections at a tertiary care center. Patients that present with a pleocytosis in the cerebral spinal fluid (CSF), defined as a CSF WBC count > 5 cells/mm3, from July 2015 to June 2016 at a tertiary care hospital were analyzed for this report. Data from patients with confirmed (n = 43) and presumed (n = 51) CNS infections were analyzed. CNS infection was the leading known cause of CSF pleocytosis (n = 43, 18% of all patients with a pleocytosis in the CSF), and HSV-2 was identified as the leading causative pathogen (n = 10) followed by varicella zoster virus (n = 5). Fifty-three percent of patients with a pleocytosis in the CSF did not receive a diagnosis. In the patients that did not receive a diagnosis, CNS infection was presumed to be the cause in 51 patients (21% of patients with CSF pleocytosis). The mean time to diagnosis for patients with confirmed CNS infection was 16 days, but time to diagnosis was highly variable depending on the causative pathogen. There was a significant overlap in CSF parameters and peripheral white blood cell counts in patients diagnosed with a viral, bacterial, or fungal infection. Neuroimaging changes were present in only 44% of CNS infections. The overall mortality was 7% for CNS infections, and 17% of patients with a CNS infection had a severe neurologic deficit at presentation while only 3% had a severe deficit at the last neurologic assessment. This study provides new insights into the infectious causes of disease in a cohort of patients with pleocytosis in the CSF. The study provides new insights into the time to diagnosis and outcomes in patients that present with pleocytosis in the CSF.


CSF pleocytosis CNS infection Encephalitis Meningitis 


Funding information

JDB is supported by grant funding VA Merit I01BX003863, DOD PRMRP PR160117 Medical Investigator-Initiated Research Award. BLB is supported in part by NIH/NCATS Colorado CTSI Grant Number UL1 TR001082.

Compliance with ethical standards

All work was reviewed and approved by the Colorado Multiple Institutional Review Board prior to data capture.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

13365_2019_739_MOESM1_ESM.docx (54 kb)
ESM 1 (DOCX 54 kb)


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Copyright information

© Journal of NeuroVirology, Inc. 2019

Authors and Affiliations

  1. 1.Clinical Science Graduate ProgramUniversity of Colorado Graduate SchoolAuroraUSA
  2. 2.Biostatistics & InformaticsColorado School of Public HealthAuroraUSA
  3. 3.Department of MedicineUniversity of Chicago School of MedicineChicagoUSA
  4. 4.Department of Medicine, Division of Infectious DiseasesUniversity of Colorado School of MedicineAuroraUSA
  5. 5.Veterans AdministrationEastern Colorado Health SystemDenverUSA
  6. 6.Department of Neurology, Division of Neuroimmunology and Neurological InfectionsUniversity of Colorado School of MedicineAuroraUSA

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