Meningitis: The Daily PANCE Blueprint

The answer is E. CSF white blood cells (WBC)/neutrophils

In bacterial meningitis, the CSF typically shows an early predominance of neutrophils. These immune cells are among the first responders to bacterial infections, leading to their increased presence in the CSF as they attempt to combat the bacteria.

Incorrect Answer Explanations:

A. CSF white blood cells (WBC)/lymphocytes – This answer is incorrect because lymphocytic predominance in the CSF is more characteristic of viral meningitis, not bacterial meningitis. In bacterial meningitis, neutrophils predominate initially.

B. CSF proteins – While the protein level in the CSF can be elevated in bacterial meningitis, this is not typically the first change observed. Protein levels increase as a response to the inflammation and increased permeability of the blood-brain barrier, which occurs after the initial neutrophilic response.

C. CSF glucose – Decreased glucose levels in the CSF are a hallmark of bacterial meningitis, but this occurs due to the consumption of glucose by both the host immune response and the bacteria. It is not the first change seen and typically follows the increase in neutrophils.

D. CSF cultures – Although CSF cultures will eventually grow the bacteria responsible for the meningitis, this is not an immediate change. It takes time for cultures to grow, making it a later finding in the diagnosis of bacterial meningitis.