Comparison of Cerebrospinal Fluid Biomarkers for Differential Diagnosis of Acute Bacterial and Viral Meningitis with Atypical Cerebrospinal Fluid Characteristics

Almeida, Sérgio Monteiro de; Furlan, Suélen Maria Parizotto; Cretella, Arianne Maris Munhoz; Lapinski, Bruna; Nogueira, Keite da Silva; Cogo, Laura Lúcia; Vidal, Luíne Rosele Renaud; Nogueira, Meri Bordignon

doi:10.1159/000501925

Cited by 18 publications

(4 citation statements)

References 21 publications

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“…Our results were close to those observed by de Almeida et al, 2020, 29 . They reported a median CSF lactate level in acute bacterial meningitis of 9.0 mmol/l (IQR=5.70-12.89).…”

Section: Discussionsupporting

confidence: 94%

Cerebrospinal Fluid Lactate as a Differential Biomarker for Bacterial and Viral Meningitis

Arafa,

Gabr,

Kamel

et al. 2023

EJI

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Meningitis is a critical public health problem demanding immediate diagnosis and effective treatment due to high mortality rates. Cerebrospinal Fluid (CSF) lactate concentration is a promising test to distinguish bacterial from viral meningitis. This study aimed to assess the performance and usefulness of CSF lactate as a biomarker to differentiate between bacterial and viral meningitis, and to determine its optimal level to differentiate between them. This prospective study included 50 patients, presented to Abbassia Fever Hospital with clinical findings consistent with meningitis. Patients were divided into two groups: Group1 included 30 patients with bacterial meningitis. Group 2 included 20 patients with viral meningitis. CSF lactate and other conventional CSF parameters were recorded. For CSF culture, Streptococcus pneumoniae was identified in 53.3% of the bacterial meningitis group. The polymerase chain reaction (PCR) indicated that S. pneumoniae was present in 26/50 (52%) and 3/50 (6%) patients were PCR negative. Among bacterial meningitis patients, S. pneumoniae was the most pervasive organism 26/30 (86.7%). The mean CSF lactate level was 9.3 mmol/l ±5.0 (2.2-17.6). There was a statistically significant strong agreement (Kappa=0.957) between types of meningitis diagnosed by PCR, culture, and CSF lactate at cutoff level of 7.2 mmol/L. This cutoff value was the best to differentiate between bacterial and viral meningitis. The validity of CSF lactate as a differentiating tool showed sensitivity, specificity, positive predictive value, and negative predictive value of 93.3%, 100%, 100%, and 90.9%, respectively. In conclusion, CSF lactate could be a valuable, sensitive, specific, and rapid marker for identifying the most dangerous bacterial causes of CNS infection, especially S. pneumoniae. CSF lactate can be routinely used as an early biochemical warning marker and a useful point-of-care test. CSF lactate at cutoff level of >7.2 mmol/L can accurately detect S. pneumoniae, the most prevalent organism in Egypt.

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“…Our results were close to those observed by de Almeida et al, 2020, 29 . They reported a median CSF lactate level in acute bacterial meningitis of 9.0 mmol/l (IQR=5.70-12.89).…”

Section: Discussionsupporting

confidence: 94%

Cerebrospinal Fluid Lactate as a Differential Biomarker for Bacterial and Viral Meningitis

Arafa,

Gabr,

Kamel

et al. 2023

EJI

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“…In untreated, immunocompetent patients with acute bacterial meningitis, the CSF is usually purulent-cloudy. It typically shows granulocytic pleocytosis with more than 1000 cells/µl, severe blood-CSF barrier dysfunction (total protein > 1000 mg/dL) and a decrease in CSF glucose (usually < 30 mg/dL; CSF/serum glucose quotient < 0.3) or an increase in CSF lactate (> 3.5 mmol/L) (Table 1 ) [ 10 – 12 ]. Depending on the pathogen, however, “atypical” findings are found in up to one third of cases: In a study of 1816 patients with pneumococcal meningitis, the cell count was < 1000/µl in 33% of patients [ 13 ].…”

Section: Guidelines In Detailmentioning

confidence: 99%

German guidelines on community-acquired acute bacterial meningitis in adults

Klein,

Abdel-Hadi,

Bühler

et al. 2023

Neurol. Res. Pract.

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Introduction The incidence of community-acquired acute bacterial meningitis has decreased during the last decades. However, outcome remains poor with a significant proportion of patients not surviving and up to 50% of survivors suffering from long-term sequelae. These guidelines were developed by the Deutsche Gesellschaft für Neurologie (DGN) under guidance of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) to guide physicians through diagnostics and treatment of adult patients with acute bacterial meningitis. Recommendations The most important recommendations are: (i) In patients with suspected acute bacterial meningitis, we recommend that lumbar cerebrospinal fluid (with simultaneous collection of serum to determine the cerebrospinal fluid-serum glucose index and blood cultures) is obtained immediately after the clinical examination (in the absence of severely impaired consciousness, focal neurological deficits, and/or new epileptic seizures). (ii) Next, we recommend application of dexamethasone and empiric antibiotics intravenously. (iii) The recommended initial empiric antibiotic regimen consists of ampicillin and a group 3a cephalosporin (e.g., ceftriaxone). (iv) In patients with severely impaired consciousness, new onset focal neurological deficits (e.g. hemiparesis) and/or patients with newly occurring epileptic seizures, we recommend that dexamethasone and antibiotics are started immediately after the collection of blood; we further recommend that —if the imaging findings do not indicate otherwise —a lumbar CSF sample is taken directly after imaging. (v) Due to the frequent occurrence of intracranial and systemic complications, we suggest that patients with acute bacterial meningitis are treated at an intensive care unit in the initial phase of the disease. In the case of impaired consciousness, we suggest that this is done at an intensive care unit with experience in the treatment of patients with severe CNS diseases. Conclusions The German S2k-guidelines give up to date recommendations for workup, diagnostics and treatment in adult patients with acute bacterial meningitis.

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“…62 As with other viral CNS infections, CSF lactate is below 3.5 mmol/L and glucose under normal. 71,72 Some cases with CHIKV meningitis showed a predominance of polymorphonuclear cells. 73 CSF pleocytosis has been found in 50% of CHIKV myelitis cases.…”

Section: Csf Analysismentioning

confidence: 99%

Review of dengue, zika and chikungunya infections in nervous system in endemic areas

Puccioni-Sohler,

Nascimento Soares,

Christo

et al. 2023

Arq Neuropsiquiatr

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Dengue, zika, and chikungunya are arboviruses of great epidemiological relevance worldwide. The emergence and re-emergence of viral infections transmitted by mosquitoes constitute a serious human public health problem. The neurological manifestations caused by these viruses have a high potential for death or sequelae. The complications that occur in the nervous system associated with arboviruses can be a challenge for diagnosis and treatment. In endemic areas, suspected cases should include acute encephalitis, myelitis, encephalomyelitis, polyradiculoneuritis, and/or other syndromes of the central or peripheral nervous system, in the absence of a known explanation. The confirmation diagnosis is based on viral (isolation or RT-PCR) or antigens detection in tissues, blood, cerebrospinal fluid, or other body fluids, increase in IgG antibody titers between paired serum samples, specific IgM antibody in cerebrospinal fluid and serological conversion to IgM between paired serum samples (non-reactive in the acute phase and reactive in the convalescent). The cerebrospinal fluid examination can demonstrate: 1. etiological agent; 2. inflammatory reaction or protein-cytological dissociation depending on the neurological condition; 3. specific IgM, 4. intrathecal synthesis of specific IgG (dengue and chikungunya); 5. exclusion of other infectious agents. The treatment of neurological complications aims to improve the symptoms, while the vaccine represents the great hope for the control and prevention of neuroinvasive arboviruses. This narrative review summarizes the updated epidemiology, general features, neuropathogenesis, and neurological manifestations associated with dengue, zika, and chikungunya infection.

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Comparison of Cerebrospinal Fluid Biomarkers for Differential Diagnosis of Acute Bacterial and Viral Meningitis with Atypical Cerebrospinal Fluid Characteristics

Cited by 18 publications

References 21 publications

Cerebrospinal Fluid Lactate as a Differential Biomarker for Bacterial and Viral Meningitis

Cerebrospinal Fluid Lactate as a Differential Biomarker for Bacterial and Viral Meningitis

German guidelines on community-acquired acute bacterial meningitis in adults

Review of dengue, zika and chikungunya infections in nervous system in endemic areas

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