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Updated: Sep 20, 2026

Metagenomic Next-Generation Sequencing of Cerebrospinal Fluid for the Detection of Central Nervous System Pathogens
10:08

Metagenomic Next-Generation Sequencing of Cerebrospinal Fluid for the Detection of Central Nervous System Pathogens

Published on: April 17, 2026

New and old diagnostic markers of meningitis in cerebrospinal fluid (CSF)

Tilmann O Kleine1, Peter Zwerenz, Peter Zöfel

  • 1Neurochemistry Department, Centre of Nervous Diseases, Clinicum of the University, D-35033 Marburg, Germany.

Brain Research Bulletin
|August 12, 2003
PubMed

Insights

Cerebrospinal fluid (CSF) lactate and interleukin-6 tests effectively differentiate bacterial meningitis from viral meningitis and multiple sclerosis. CSF lactate alone can distinguish treated bacterial meningitis from viral meningitis.

Area of Science:

  • Clinical Neurology
  • Infectious Diseases
  • Biomarker Discovery

Background:

  • Accurate differentiation of meningitis types is crucial for timely and appropriate treatment.
  • Distinguishing bacterial meningitis (BM) from aseptic meningitis (AM) and multiple sclerosis (MS) presents diagnostic challenges.
  • Novel biomarkers are needed to improve diagnostic accuracy alongside established markers.

Purpose of the Study:

  • To evaluate new and existing cerebrospinal fluid (CSF) and serum markers for discriminating BM from AM.
  • To differentiate treated bacterial meningitis (TM) from AM.
  • To distinguish AM from MS using biochemical and cellular markers.

Main Methods:

  • Analysis of 180 CSF and serum pairs from patients with BM, AM, TM, and MS.
  • Evaluation of five new markers (TNF-alpha, IL-1 beta, IL-6, IL-8, LBP) and 11 classical markers.
  • Statistical analysis to determine sensitivity, specificity, and correct classification rates for various diagnostic scenarios.

Main Results:

  • CSF IL-6 (≥500 ng/l) and IL-1 beta (≥8 ng/l), along with CSF lactate (≥3.5 mmol/l) and granulocytes (≥150 M/l), accurately discriminated BM from AM (>90% accuracy).
  • CSF lactate (≥3.2 mmol/l) differentiated TM from AM.
  • CSF leukocytes (≥35 M/l) distinguished AM from MS.

Conclusions:

  • CSF lactate and specific interleukin levels are valuable biomarkers for differentiating meningitis types and MS.
  • While new markers like IL-6 and IL-1 beta show promise, CSF lactate is a more practical and cost-effective option for certain distinctions.
  • All diagnostic tests should be interpreted in conjunction with clinical findings for reliable diagnosis of bacterial meningitis.

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