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Cerebrospinal fluid lactate in 78 cases of adult meningitis
1Département de Médecine Interne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Abstract:
In a retrospective study of 78 cases of adult meningitis, the CSF lactate was measured on the first spinal tap (ST); 25 had a bacterial meningitis, 28 a viral meningitis; 22 other cases had been on antibiotics prior to admission; 3 cases had meningitis of rare aetiology. The median CSF lactate level among the 25 bacterial cases amounted to 13.6 mmol/l (range: 3.5-24.5) whereas it remained low in the 28 viral cases: 2.7 mmol/l (range: 1.4-4.2). These differences are highly significant. The comparison of the CSF lactate level with the other tests routinely performed showed that the CSF lactate level had the highest sensitivity, specificity and predictive values. The CSF lactate level on the first ST had no prognostic value, but a rapid decrease of the CSF lactate during the treatment is indicative of good prognosis. Among the pretreated cases, a high lactate level could be an indication that bacteria were the causal agents. In conclusion, the measurement of the CSF lactate, quickly performed and inexpensive, is worth performing when a meningitis is suspected, as it appears to be the best way of distinguishing bacterial from non-bacterial meningitis.
Insights
Cerebrospinal fluid (CSF) lactate levels effectively distinguish bacterial meningitis from viral meningitis. High CSF lactate indicates bacterial infection, while rapid lactate decrease suggests a good prognosis.
Area of Science:
- Neurology
- Infectious Diseases
- Biochemistry
Background:
- Meningitis is a serious infection requiring rapid diagnosis.
- Distinguishing bacterial from viral meningitis is crucial for appropriate treatment.
- Current diagnostic methods have limitations in speed and accuracy.
Purpose of the Study:
- To evaluate the utility of cerebrospinal fluid (CSF) lactate levels in diagnosing adult meningitis.
- To compare the diagnostic performance of CSF lactate with other routine tests.
- To assess the prognostic value of CSF lactate levels.
Main Methods:
- Retrospective analysis of 78 adult meningitis cases.
- Measurement of CSF lactate on the first spinal tap (ST).
- Comparison of CSF lactate levels across different meningitis etiologies (bacterial, viral, pre-treated, rare).
Main Results:
- Significantly higher median CSF lactate in bacterial meningitis (13.6 mmol/l) vs. viral meningitis (2.7 mmol/l).
- CSF lactate demonstrated superior sensitivity, specificity, and predictive values compared to other tests.
- Initial CSF lactate had no prognostic value, but a rapid decrease during treatment indicated a good prognosis.
Conclusions:
- CSF lactate measurement is a valuable, rapid, and inexpensive tool for differentiating bacterial from non-bacterial meningitis.
- Elevated CSF lactate in pre-treated cases may suggest bacterial etiology.
- Monitoring CSF lactate decrease during treatment aids in prognosis assessment.