Rapid Diagnosis of Meningitis with Use of Selected Clinical Data and Gas-Liquid Chromatographic Determination of Lactate Concentration in Cerebrospinal Fluid

Abstract

The usefulness of determination of lactate concentration in cerebrospinal fluid (CSF) for differentiation between various types of meningitis was evaluated. Lactate concentration in the CSF was assayed by gas-liquid chromatography for 115 patients, 17 of whom had serous meningitis and 38 had bacterial meningitis. The mean lactate concentration in the CSF of patients with bacterial meningitis was significantly higher than in the CSF of patients with serous meningitis and in a control group. The mean concentration in patients with serous meningitis was significantly higher than in controls. The highest lactate level in serous meningitis overlapped with the lowest level in bacterial meningitis. Elevated lactate concentrations in CSF were found also in patients with noninfectious disorders of the central nervous system. Misleading results may therefore be obtained if the lactate concentration in CSF alone is used to distinguish between serous and bacterial meningitis. The study suggests, however, that measurements of lactate levels in CSF, when combined with clinical and conventional laboratory observations, can increase the reliability of rapid diagnosis of bacterial meningitis.

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

“…This is in contrast to the usual findings of normal lactate concentrations in viral meningitis (19)(20)(21)(22)(23)(24)(25)(26)(27). CSF lactate concentrations are also increased in fungal meningitis.…”

Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis

“…A total of 90 articles were excluded from final analysis due to the following reasons: (1) comment/review/guidelines/reply/case report ( n = 22), (2) non-English language ( n = 1), (3) no lactate concentration ( n = 7), (4) no BM or AM group ( n = 20), (5) in vitro or animal research ( n = 3), (6) unable to exclude partially treated patients ( n = 6), (7) unable to extract data ( n = 11), and (8) low number of participants ( n = 20). Finally, 25 studies were selected for final analysis [11,12,37-58] with agreement between the two reviewers (κ = 0.898).…”

“…Nineteen studies [11,12,38,39,41-43,46-56,59] that analyzed only diagnosed BM and five other studies [37,40,44,45,57] that included diagnosed BM as well as clinical BM that could be extracted separately were included in the subgroup analysis. The specificity and LR+ were heterogeneous among the studies, but sensitivity, LR-, and DOR were significantly homogenous (data not shown).…”

“…However, other researchers have suggested that CSF lactate offers no additional clinically useful information over conventional CSF markers [11,12]. Other markers, such as C-reactive protein (CRP) [13] and procalcitonin [14], may allow differentiation of patients with bacterial meningitis from those with aseptic meningitis.…”

“…However, neither of these markers is routinely used in clinical practice [4]. The reported diagnostic accuracy of CSF lactate for the differential diagnosis of BM from AM has varied across studies [11,12]. To adequately evaluate its accuracy, a systematic review and meta-analysis were performed on studies that had investigated the CSF lactate concentration as a differential marker in both BM and AM patients.…”