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Cerebro-spinal lactate status in childhood pyogenic meningitis in Nigeria
S Imuekehme1, J Obi, W Alakija
1Department of Paediatrics, Specialist Hospitals, Benin City, Edo State, Nigeria.
Insights
Elevated cerebrospinal fluid (CSF) lactate levels in children with pyogenic meningitis may indicate a poor prognosis and increased mortality. CSF lactate can offer rapid diagnostic and evaluation information during treatment.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Pyogenic meningitis is a severe infection in children.
- Cerebrospinal fluid (CSF) lactate is a potential biomarker for bacterial meningitis.
- Limited data exists on CSF lactate levels in Nigerian children with pyogenic meningitis.
Purpose of the Study:
- To determine the status of CSF lactate levels in Nigerian children diagnosed with pyogenic meningitis.
- To explore the correlation between CSF lactate levels and patient outcomes, including neurological deficits and mortality.
Main Methods:
- A cohort of 40 Nigerian children (1 month to 12 years) with confirmed pyogenic meningitis was studied over 8 months.
- CSF lactate levels were measured on admission and at discharge/death.
- Outcomes assessed included recovery with or without neurological deficit, and mortality.
Main Results:
- All patients with pyogenic meningitis exhibited mean CSF lactate levels exceeding 25 mg/dl.
- Patients with neurological deficits had higher CSF lactate levels than those without, though not statistically significant.
- Deceased patients consistently showed high mean CSF lactate levels from admission through to death.
Conclusions:
- Persistently elevated CSF lactate in pyogenic meningitis, even with antibiotic treatment, suggests a poor prognosis and higher mortality risk.
- CSF lactate determination is a valuable, rapid tool for diagnosis and treatment evaluation in meningitis, complementing conventional tests.
Abstract:
This study was undertaken to ascertain the status of cerebrospinal (CSF) lactate level in Nigerian children with pyogenic meningitis. Forty patients aged from 1 month to 12 years with proven meningitis were the subjects in the study which lasted 8 months. All the patients who had pyogenic meningitis had mean cerebrospinal lactate level over 25 mg/dl. The patients who recovered with neurological deficit had higher level of cerebrospinal lactate than those who recovered without any neurological deficit, on admission and on-discharge, although the differences were not statistically significant. The patients who died had persistently high mean CSF lactate on admission and at death. The study suggests that persistently elevated CSF lactate in cases of pyogenic meningitis receiving adequate antibiotic therapy might indicate poor prognosis with increased mortality. It is not being suggested that CSF lactate determination should replace the conventional tests for meningitis. However, it can provide pertinent, rapid, and reliable diagnostic information, and can also provide useful evaluation information at different stages of treatment of proven meningitis with appropriate antibiotics.