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Cerebrospinal fluid lysozyme in bacterial and viral meningitis
Abstract:
The concentration of lysozyme (LZM) in cerebrospinal fluid was determined in 25 patients with bacterial meningitis, in 18 patients with viral meningitis and in 25 control patients who had other fibrile illnesses. The concentration of LZM was less than 1.5 microgram/ml in all control patients, and slightly to markedly raised in 10 patients with viral meningitis and in 11 out of 13 patients with untreated bacterial meningitis. The concentration of LZM was significantly different in the viral and bacterial meningitis patients (p less than 0.001). Most raised concentrations of cerebrospinal fluid LZM persisted for at least one week after the start of antibiotic treatment. The concentrations of LZM correlated well with concentrations of lactic dehydrogenase. These results show that the determination of cerebrospinal fluid LZM is a useful tool in the differential diagnosis of meningitis, particularly when the prehospital treatment with antibiotics may be responsible for a diagnostically misleading negative bacterial culture of the cerebrospinal fluid and altered cerebrospinal fluid cytology.
Insights
Cerebrospinal fluid lysozyme (LZM) levels can help differentiate between viral and bacterial meningitis. Elevated LZM concentrations are indicative of bacterial meningitis, even with prior antibiotic treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Biochemistry
Background:
- Meningitis diagnosis can be challenging, especially with pre-treatment.
- Cerebrospinal fluid (CSF) analysis is crucial for differentiating meningitis types.
Purpose of the Study:
- To evaluate the diagnostic utility of CSF lysozyme (LZM) in distinguishing bacterial from viral meningitis.
- To assess LZM levels in patients with other febrile illnesses.
Main Methods:
- CSF samples were analyzed for LZM concentration in 25 bacterial meningitis patients, 18 viral meningitis patients, and 25 controls.
- LZM levels were compared between groups and correlated with lactic dehydrogenase (LDH).
Main Results:
- Control patients had LZM < 1.5 microgram/ml.
- Elevated LZM was observed in viral meningitis and untreated bacterial meningitis patients.
- Significant differences in LZM were found between viral and bacterial meningitis groups (p < 0.001).
- High LZM levels persisted for at least one week post-antibiotic treatment.
- CSF LZM correlated with CSF LDH concentrations.
Conclusions:
- CSF LZM determination is a valuable tool for differential diagnosis of meningitis.
- LZM aids diagnosis when bacterial cultures are negative due to antibiotics.
- LZM offers a reliable biomarker for bacterial meningitis.