Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: A meta-analysis

Sakushima, Ken; Hayashino, Yasuaki; Kawaguchi, Takehiko; Jackson, Jeffrey L.; Fukuhara, Shunichi

doi:10.1016/j.jinf.2011.02.010

Cited by 206 publications

(114 citation statements)

References 50 publications

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“…CSF lactate concentration may differentiate bacterial from viral meningitis better than white blood cell count, glucose level, and protein concentration, although CSF lactate may be elevated in patients with other CNS diseases. 42,43 The level of protein can be elevated in many infectious and noninfectious diseases as well as in traumatic lumbar puncture and subarachnoid bleeding. Creatinine kinase and lactate dehydrogenase (LDH) CSF levels are also high in pyogenic or tubercular meningitis.…”

Section: Laboratory Testsmentioning

confidence: 99%

Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis

Rigakos¹,

Liakou²,

Felipe

et al. 2017

Cancer Control

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Section: Laboratory Testsmentioning

confidence: 99%

Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis

Rigakos¹,

Liakou²,

Felipe

et al. 2017

Cancer Control

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“…These findings prompted us to elaborate a CSF processing strategy to limit urgent and inappropriate microbiological tests while maintaining an optimal performance for diagnosing ABM. The strategy was based on a simple score, the BM-CASCO, calculated from a set of five parameters derived from the initial clinical chemistry workup that were chosen by a review of the literature (5)(6)(7)9). Although previous scoring systems have been proposed to distinguish bacterial from viral meningitis (12)(13)(14)(15)(16), to the best of our knowledge, this is the first scoring system based only on clinical chemistry data for triage of suspected cases of ABM in adults to be subjected to further microbiological analysis of CSF.…”

Section: Discussionmentioning

confidence: 99%

Proposal for a New Score-Based Approach To Improve Efficiency of Diagnostic Laboratory Workflow for Acute Bacterial Meningitis in Adults

Lagi

Bartalesi

Pecile³

et al. 2016

J Clin Microbiol

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Microbiological tests on cerebrospinal fluid (CSF) utilize a common urgent-care procedure that does not take into account the chemical and cytological characteristics of the CSF, resulting sometimes in an unnecessary use of human and diagnostic resources. The aim of this study was to retrospectively validate a simple scoring system (bacterial meningitis-Careggi score [BM-CASCO]) based on blood and CSF sample chemical/cytological parameters for evaluating the probability of acute bacterial meningitis (ABM) in adults. BM-CASCO (range, 0 to 6) was defined by the following parameters: CSF cell count, CSF protein levels, CSF lactate levels, CSF glucose-to-serum glucose ratio, and peripheral neutrophil count. BM-CASCO was retrospectively calculated for 784 cases of suspected ABM in adult subjects observed during a four-and-a-halfyear-period (2010 to 2014) at the emergency department (ED) of a large tertiary-care teaching hospital in Italy. Among the 28 confirmed ABM cases (3.5%), Streptococcus pneumoniae was the most frequent cause (16 cases). All ABM cases showed a BM-CASCO value of >3. Most negative cases (591/756) exhibited a BM-CASCO value of <1, which was adopted in our laboratory as a cutoff to not proceed with urgent microbiological analysis of CSF in cases of suspected ABM in adults. During a subsequent 1-year follow-up, the introduction of the BM-CASCO in the diagnostic workflow of ABM in adults resulted in a significant decrease in unnecessary microbiological analysis, with no false negatives. In conclusion, BM-CASCO appears to be an accurate and simple scoring system for optimization of the microbiological diagnostic workflow of ABM in adults. C ases of acute bacterial meningitis (ABM) require prompt diagnosis and treatment due to significant mortality rates (1, 2). A delay in starting appropriate therapy may worsen the prognosis (1). Recently, the epidemiology of ABM has shifted to older age groups due to the increasing child vaccination rates against the most common meningeal pathogens (3, 4). Streptococcus pneumoniae is currently the leading cause of ABM in adults and is associated with a 17 to 30% mortality rate (2-4).Diagnosis of ABM at the time of clinical presentation is often difficult and requires laboratory investigation of cerebrospinal fluid (CSF) specimens. A Gram stain of the CSF sediment is a widely used test for the rapid detection of bacteria but may suffer from low sensitivity (5). When evaluated on adult subjects not previously treated with antibiotics, the CSF Gram stain has been reported to have a sensitivity between 60% and 92% (6). Sensitivity can be increased by molecular tests, such as real-time PCR (RT-PCR), but these tests are still not widespread due to their high cost and the need for expensive equipment and experienced laboratory personnel. Bacterial culture remains the gold standard for microbiological diagnosis of ABM, but it requires longer times and suffers from reduced sensitivity in cases involving previous antimicrobial chemotherapy (6). In addition, biochemical and cyto...

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“…[29] CSF lactate has the ability to differentiate bacterial meningitis from aseptic meningitis with robust accuracy; however, this test is often unavailable. [30,31] Serum CRP and procalcitonin are useful markers as well, with the latter carrying a strong diagnostic odds ratio. [32,33] Molecular diagnostic testing, such as nuclear acid amplification tests, has been shown to facilitate the diagnosis in 33% of patients in whom the diagnosis could not be made conventionally.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic challenges with acellular bacterial meningitis

Moolla

Naidoo

2016

S Afr Med J

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Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: A meta-analysis

Abstract: word count: 210 words

Cited by 206 publications

References 50 publications

Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis

Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis

Proposal for a New Score-Based Approach To Improve Efficiency of Diagnostic Laboratory Workflow for Acute Bacterial Meningitis in Adults

Diagnostic challenges with acellular bacterial meningitis

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