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The diagnostic and predictive value of cerebrospinal fluid lactate in children with meningitis. Its relation to
Insights
Cerebrospinal fluid (CSF) lactate levels are a better indicator of bacterial meningitis in children than glucose ratios. Elevated lactate reliably predicts bacterial meningitis, aiding antibiotic treatment decisions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Chemistry
Background:
- Meningitis is a serious infection requiring prompt diagnosis and treatment.
- Accurate differentiation between bacterial and aseptic meningitis is crucial for appropriate management.
- Current diagnostic methods for meningitis in children have varying degrees of accuracy.
Purpose of the Study:
- To evaluate the diagnostic utility of cerebrospinal fluid (CSF) lactate levels in children with suspected meningitis.
- To compare the effectiveness of CSF lactate with other routine laboratory methods, including CSF/blood glucose ratio and cell counts.
Main Methods:
- Investigated 133 children (11 days to 16 years) with suspected meningitis.
- Analyzed routine CSF laboratory tests: Gram stain, bacterial culture, leukocyte count, lactate, and CSF/blood glucose ratio.
- Classified patients into bacterial meningitis (n=18), aseptic meningitis (n=28), and control (n=87) groups based on cultures and clinical course.
Main Results:
- CSF lactate levels and cell counts correlated significantly (p<0.01) better with bacterial meningitis than CSF/blood glucose ratios.
- All children with bacterial meningitis had CSF lactate levels >2.4 mmol/l.
- No control group children had CSF lactate levels >2.4 mmol/l; 3 aseptic meningitis cases had levels between 2.5-2.7 mmol/l.
Conclusions:
- CSF lactate is a highly sensitive and specific marker for bacterial meningitis in children.
- CSF lactate levels are superior to CSF/blood glucose ratios in diagnosing bacterial meningitis.
- CSF lactate measurement is a valuable tool to guide the initiation of antibiotic therapy in suspected pediatric meningitis cases.
Abstract:
One hundred and thirty-three children with suspected meningitis aged from 11 days to 16 years were investigated with routine cerebrospinal fluid (CSF) laboratory methods: microscopy of a Gram-stained smear, bacterial culture, determination of leukocytes, lactate, and the CSF/blood glucose ratio. On the basis of bacterial cultures and clinical course, the children were classified into three groups: bacterial meningitis (n = 18), aseptic meningitis (n = 28), and a control group (n = 87). The main intention was to study the relation between current diagnostic methods and lactate. CSF lactate levels and cell counts, related significantly (p less than 0.01) better to the presence of bacterial meningitis than CSF/blood glucose ratios. Lactate levels exceed 2.4 mmol/l in all children with bacterial meningitis, but in none of the control group. Of 28 children with aseptic meningitis 3 had lactate in the range 2.5-2.7 mmol/l, while the others had values of 2.4 mmol/l or less. We consider CSF lactate to be the best predictor in the clinical decision to institute antibiotic treatment of children with suspected bacterial meningitis.