Quantitation of cerebrospinal fluid lactic acid in infectious and non-infectious neurological diseases

Abstract

Background: The differential diagnosis between bacterial and viral meningitis is not easy in some cases. Cerebrospinal fluid (CSF) analysis is essential for establishing this diagnosis. The objectives were to quantitate lactic acid (LA) concentrations in bacterial and viral meningitis, and other central nervous system (CNS) diseases in order to evaluate the diagnostic utility of CSF LA for discriminating bacterial from viral meningitis. Methods: CSF LA was measured in 139 CSF samples from seven groups: viral meningitis with classic CSF; suspicion of viral meningitis with neutrophils in CSF; bacterial meningitis; non-infectious neurological diseases; chronic meningitis; traumatic lumbar puncture (LP) and normal CSF. Results: CSF LA was higher in bacterial meningitis 8.7q5.4 mmol/L compared with viral meningitis (1.9q0.6) and the other groups (p-0.0001). CSF LA in the groups with viral meningitis was not different compared to groups with non-infectious CNS diseases and chronic meningitis. The ability of CSF LA to discriminate bacterial from viral meningitis showed a sensitivity of 80% and specificity of 97%, positive predictive value (PPV) of 94%, and negative predictive value (NPV) of 89%. Conclusions: CSF LA is a powerful test to discriminate bacterial from viral meningitis with high sensitivity,

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

“…Approximately 50% of patients with granulocytopenia who have acute BM have < 5 cells/ mm 3 in the CSF, which can be confirmed by a positive Gram stain, CSF culture, and serological results [1]. We did not observe any correlation between CSF and blood lactate, corroborating previous observations [1,24]. As traumatic LP is common in CSF samples in a routine laboratory, the effect of any resulting CSF RBC on CSF lactate concentrations was assessed.…”

Enterovirus and herpesviridae family as etiologic agents of lymphomonocytary meningitis, Southern Brazil

“…The involvement of herpesviruses as etiologic agents of meningitis or encephalitis has been extensively described in immunocompetent as well as immunossupressed patients [23][24][25] . Some authors report the difficulty to distinguish aseptic from bacterial meningitis due to the overlap of clinical symptoms and laboratory findings 26,27 . In this context, CSF examination is an essential part of the diagnostic analysis of patients with suspected CNS viral infection 28 .…”

Nosocomial meningitis caused by Klebsiella pneumoniae producing carbapenemase, with initial cerebrospinal fluid minimal inflammatory response

“…CSF lactic acid and CSF/serum glucose rates fell within normal ranges; despite both are sensitive and specific biomarkers to differentiate bacterial from nonbacterial meningitis 4 . These conditions may therefore confound or delay correct diagnosis leading to delay in the initiation of antibiotic therapy.…”