What is the role of cerebrospinal fluid (CSF) cultures or assays in the diagnosis of Lyme meningitis?

Updated: Jul 16, 2019
  • Author: Rodrigo Hasbun, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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CSF culture for B burgdorferi has a low yield. The CSF Lyme PCR assay, if available, offers a rapid, sensitive, and specific method of diagnosis. This assay is gaining popularity as the method of choice for diagnosing Lyme meningitis.

Cohn et al validated a clinical prediction rule for differentiating Lyme meningitis from aseptic meningitis. Their “rule of 7s” classifies children at low risk for Lyme meningitis when all of the following 3 criteria are met [30] :

  • < 7 days of headache

  • < 70% CSF mononuclear cells

  • Absence of cranial nerve VII palsy or other cranial nerve palsy

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