Performance of lactate in discriminating bacterial meningitis from enteroviral meningitis

Abstract

The cytological and biochemical examination of cerebrospinal fluid (CSF) has been used for the presumed diagnosis of bacterial meningitis until the final microbiological results are achieved. We assessed the ability of CSF lactate in comparison with other CSF parameters to discriminate bacterial and enteroviral community acquired meningitis. We included 1,187 CSF samples of acute community-acquired meningitis, being 662 cases of bacterial and 525 of enteroviral meningitis. Lactate concentration (mg/dL), leukocyte count/mm 3 , protein (mg/dL), and glucose (mg/dL) were compared between bacterial and viral meningitis. Receiver operator characteristic (ROC) curves were used to assess diagnostic performance. CSF leukocytes, CSF protein and CSF lactate were significantly higher in bacterial meningitis cases (P<0.0001). CSF glucose was significantly lower in bacterial meningitis cases (P<0.0001). CSF lactate showed the best predictive ability with an area under the curve of 0.944 (95% CI 0.929 – 0.959). Considering a cut off of CSF lactate of 30 mg/dL, the sensitivity and specificity for bacterial meningitis were 84.1% and 99%, respectively. In the cytological and biochemical CSF analysis, CSF lactate was the most accurate marker for bacterial meningitis.

<p>Management of Acute Bacterial Meningitis in Children</p>

“…CSF lactate was found to be a useful tool to differentiate bacterial from viral meningitis when elevated. [49][50][51] In one study a cut-off of 54mg/dL had a sensitivity of 90%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 96.3%, with an accuracy of 97.2%. 49 Two meta-analyses conducted to evaluate the role of CSF lactate in differentiating viral from bacterial meningitis, one including 25 studies with 1692 patients (adults and children) 52 and the other including 31 studies with 1885 patients, 53 concluded that the diagnostic accuracy of CSF lactate is better than that of the CSF white blood cell count, glucose concentration, and protein level in patients who did not receive prior antimicrobial therapy.…”

FilmArray Meningitis/Encephalitis (ME) panel in the diagnosis of bacterial meningitis

“…Conventional microbiological methods, including Gram stain, antigen detection, and culture are either poorly sensitive or take a long time for a final result. 1 , 2 The use of molecular biology methods has contributed to improve this scenario with more sensitive and rapid diagnoses. 3 …”

Diagnostic accuracy of cerebrospinal fluid lactate in confirmed cases of acute bacterial meningitis in children

“…Giulieri et al 10 also suggested that CSF lactate had the highest accuracy for discriminating bacterial from viral meningitis, with a cutoff set at 3.5 mmol/l and should be included in the initial diagnostic workup of this condition. Julián-Jiménez et al 1 , Domingues et al 17 and Buch et al 18 also reported that CSF lactate was more accurate We believe that this is among the first studies from Punjab highlighting the importance of CSF lactate in diagnosis of acute bacterial meningitis. We could not find out local references to compare our results.…”

“…Giulieri et al 10 also suggested that CSF lactate had the highest accuracy for discriminating bacterial from viral meningitis, with a cutoff set at 3.5 mmol/l and should be included in the initial diagnostic workup of this condition. Julián-Jiménez et al 1 , Domingues et al 17 and Buch et al 18 also reported that CSF lactate was more accurate than other CSF markers to identify bacterial meningitis. Pires et al 19 found lactate as the best single CSF marker of bacterial meningitis with high sensitivity and specificity of CSF lactate in a pediatric population.…”

“…One important characteristic is that this does not depend on the blood lactate level. 6 Filho et al, 7 Chen et al, 8 Barros et al, 9 Giulieri et al 10 and Cunha et al 11 found that CSF lactate may be a good biomarker that can differentiate bacterial meningitis from aseptic meningitis. Meta-analyses by Sakushima et al 12 and Huy et al 13 have reported excellent predictive power for lactate and also showed reduced diagnostic power of lactate in patients who had previously received antimicrobial drugs.…”