Evaluation of Lactate in Differentiating Pyogenic and Non-Pyogenic Meningitis
Keywords:
CSF lactate, Kernig’s sign, Meningitis, SeizuresAbstract
Background : Meningitis is serious and a life-threatening condition among any age group associated with serious mortality and morbidity. The objective of the present research was to assess the efficiency of CSF lactate in differentiating bacterial/ pyogenic from non-pyogenic meningitis. Subjects and Methods: A hospital-based one-year prospective study was conducted at a tertiary care hospital in Gujarat. The study was performed at the department of General medicine for a period of one year. All the cases suspected of meningitis above 18 years of age irrespective of sex were admitted and clinically evaluated. The Diagnosis of meningitis was made on account of various clinical symptoms and signs. Like headache, nausea, presence of kernig’s sign, altered sensorium, cranial nerves palsies, hemiparesis, seizures, etc, Results: The mean total cell count was highest in cases of pyogenic meningitis with a mean of 840.50 and SD of 112.30 than viral and tubercular meningitis. However, no statistical significance was associated with total count and types of meningitis. (P> 0.05) Lactate levels of the CSF were elevated than normal in both pyogenic and tubercular than viral, however, the mean CSF lactate was higher in pyogenic than tubercular. A clear statistical significance was observed in CSF sugar/blood glucose ratio and CSF lactate levels in this study (p≤0.05). Conclusion: CSF lactate level is a rapid, quite inexpensive and unpretentious process, important diagnostic indicator in the premature demarcation of pyogenic meningitis and tubercular meningitis from viral meningitis, serving in the premature organization of proper action and diminishing transience and impediments. Early detection may help in early decision on the type and institution of appropriate management could reduce the mortality and morbidity of meningitis.
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References
1. Ginsberg L, Kidd D. Chronic and recurrent meningitis. Pract Neurol. 2008;8(6):348–361. Available from: https://dx.doi.org/ 10.1136/jnnp.2008.157396.
2. Bacterial KR, Meningitis. Curr Treat Options Neurol. 1999;1:147–156.
3. Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice Guidelines for the Management of Bacterial Meningitis. Clin Infect Dis. 2004;39(9):1267–1284. Available from: https://dx.doi.org/10.1086/425368.
4. Tavares WM, Machado AG, Matushita H, Plese JPP. CSF markers for diagnosis of bacterial meningitis in neurosurgi cal postoperative patients. Arquivos de Neuro-Psiquiatria. 2006;64(3a):592–595. Available from: https://dx.doi.org/10. 1590/s0004-282x2006000400012.
5. Cunha BA. Distinguishing bacterial from viral meningitis: the critical importance of the CSF lactic acid levels. Intensive Care Med. 2006;32(8):1272–1273. Available from: https://dx.doi. org/10.1007/s00134-006-0210-x.
6. Gastrin B, Briem H, Rombo L. Rapid Diagnosis of Meningitis with Use of Selected Clinical Data and Gas-Liquid Chromatographic Determination of Lactate Concentration in Cerebrospinal Fluid. Int J Infect Dis. 1979;139(5):529–533. Available from: https://dx.doi.org/10.1093/infdis/139.5.529.
7. Ruuskanen O, Stãhlberg ML, Korvenranta H, Nikoskelainen J, Irjala K. CSF Lactate in Bacterial Meningitis with Minimal CSF Abnormalities. Acta Paediatr. 1985;74(2):292–293. Available from: https://dx.doi.org/10.1111/j.1651-2227.1985. tb10968.x.
8. Rajs G, Finzi-Yeheskel Z, Rajs A, Mayer M. C-Reactive Protein Concentrations in Cerebral Spinal Fluid in Gram positive and Gram-negative Bacterial Meningitis. Clin Chem. 2002;48(3):591–592. Available from: https://dx.doi.org/10. 1093/clinchem/48.3.591.
9. Santotoribio JD, Cuadros-Muñoz JF, García-Casares N. Com parison of C Reactive Protein and Procalcitonin Levels in Cere brospinal Fluid and Serum to Differentiate Bacterial from Viral Meningitis. Ann Clin Lab Sci. 2018;48(4):506–10.
10. Roos KL, Tyler KL. Meningitis, Encephalitis, Brain Abscess, and Empyema. Harrison’s Principles of Internal Medicine. New York; 2004.
11. Holub M, Beran O, Dzypova O, Hnykoya J, Lacinova Z, Prihodova J. Cortisol levels in cerebrospinal fluid correlate with severity and bacterial origin of meningitis. Crit Care. 2007;11(2):41–41. Available from: https://doi.org/10.1186/ cc5729.
12. Harrell A, Durack FE, T D. Differential diagnosis of acute meningitis: an analysis of the predictive value of initial observations. JAMA. 1989;262(19):2700–2707.
13. Genton B, Berger JP. Cerebrospinal fluid lactate in 78 cases of adult meningitis. Intensive Care Med. 1990;16(3):196–200. Available from: https://dx.doi.org/10.1007/bf01724802.
14. van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical Features and Prognostic Factors in Adults with Bacterial Meningitis. N Engl J Med. 2004;351(18):1849–1859. Available from: https://dx.doi.org/ 10.1056/nejmoa040845.
15. Heyderman RS, Lambert HP, O’Sullivan I, Stuart JM, Taylor BL, Wall RA. Early Management of Suspected Bacterial Meningitis and Meningococcal Septicaemia in Adults. J Infect. 2003;46(2):75–77. Available from: https://dx.doi.org/10.1053/ jinf.2002.1110.
16. Jagadish G, Asuti S, Narayan A. Estimation of CSF lactate as a diagnostic marker to differentiate pyogenic meningitis from nonpyogenic meningitis. J Neurosci. 2019;5(3):106–112. Available from: https://dx.doi.org/10.18231/j.ijn.2019.015.
17. Chavanet P, Schaller C, Levy C, Flores-Cordero J, Arens M, Piroth L, et al. Performance of a predictive rule to distinguish bacterial and viral meningitis. J Infect. 2007;54(4):328–336. Available from: https://dx.doi.org/10.1016/j.jinf.2006.06.009.
18. Singh K, Usmani R, Haque F, Tanweeruddin SS, Singh M, K B. Estimation of Lactate Dehydrogenase Activity in cerebrospinal fluid in different types of meningitis. Int J Adv Biolog Biomed Res. 2017;5(1):48–51.
19. Baker RC, Lenane AM. The predictive value of cerebrospinal fluid differential cytology in meningitis. Pediatr Infect Dis J. 1989;8(5):329–359.
20. Ray P, Badarou-Acossi G, Viallon A, Boutoille D, Arthaud M, Trystram D, et al. Accuracy of the cerebrospinal fluid results to differentiate bacterial from non bacterial meningitis, in case of negative gram-stained smear. Am J Emerg Med. 2007;25(2):179–184. Available from: https://dx.doi.org/10. 1016/j.ajem.2006.07.012.
