Lumbar puncture (LP)

Clinical description

All children with suspected meningitis should have an LP performed and start standard treatment for bacterial meningitis. In addition to clinical signs and symptoms, suspect TB meningitis (TBM) if the CSF demonstrates the following:

44 National Tuberculosis Control Programme

• An elevated WBC count with a lymphocytic predominance
• A high protein level, and/or
• A low glucose concentration.

If a child does not respond to standard antibiotic treatment for bacterial meningitis after 48 hours, repeat the LP.

Note: Absence of bacilli on microscopy or a negative Gene Xpert result does not exclude a diagnosis of TBM.