Dosage of lactate in the cerebrospinal fluid in infectious diseases of the central nervous system

Abstract

-This paper analyzes the diagnosis aid of the dosage of lactate in the cerebrospinal fluid (CSF) in infectious diseases of the central nervous system (CNS). We analyzed prospectively 130 samples of CSF of 116 patients with diagnoses of infectious processes in the CNS. The 130 samples of CSF were divided into five groups: 28 samples of the control group, 40 of bacterial meningitis, 22 of viral meningitis, 16 of fungal meningitis and 24 of patients presenting acquired immune deficiency syndrome (AIDS). The concentration of lactate in the CSF was elevated in the group of patients with bacterial meningitis (average = 46.2 mg/dL), fungal meningitis (average = 27.3 mg/dL) and in the AIDS group (average = 23.5 mg/dL). In the control group and viral meningitis group the lactate content in the CSF presented the reference rates according to the employed method. The lactate dosage in the CSF presented a negative correlation with glycorrhachia and positive correlation with the cellularity and total proteins of the CSF. We conclude that the lactate dosage in the CSF, although unspecific, helps to distinguish the infectious processes of the CNS.KEY WORDS: lactate, cerebrospinal fluid, central nervous infections. Dosagem de lactato no líquido cefalorraqueano em moléstias infecciosas do sistema nervoso central RESUMO -O presente estudo tem como objetivo analisar o auxílio diagnóstico da dosagem do lactato no líquido cefalorraqueano (LCR) em moléstias infecciosas do sistema nervoso central (SNC). Foram estudadas, de modo prospectivo, 130 amostras de LCR de 116 pacientes com diagnóstico de processos infecciosos do SNC. As 130 amostras de LCR foram distribuídas em cinco grupos, sendo: 28 amostras controles, 40 meningite bacteriana, 22 meningite viral, 16 meningite fúngica e 24 pacientes com a síndrome da imunodeficiência humana adquirida (SIDA). A concentração do lactato no LCR estava elevada no grupo de pacientes com meningite bacteriana (média=46,20 mg/dL), meningite fúngica (média=27,37 mg/dL) e no grupo SIDA (média=23,54 mg/dL). Nos grupos controle e de meningite viral o teor de lactato no LCR encontrava-se entre os valores de referência para o método utilizado. A dosagem do lactato no LCR apresentou correlação negativa com a glicorraquia, e positiva com a celularidade e proteínas totais do LCR. Em conclusão, a dosagem do lactato no LCR, apesar de inespecífica, auxilia na distinção entre processos infecciosos do SNC. PALAVRAS-CHAVE: ácido láctico, líquido cefalorraqueano, infecções do sistema nervoso central.

Cerebrospinal fluid lactate in post-neurosurgical bacterial meningitis diagnosis

“…We found similar results for lactate (0.96, range: 0.93-1.00). Our study showed that CSF lactate was also effective in distinguishing between CSF samples taken while on antibiotic therapy, when CSF cultures were negative; a finding also published in the report by Cunha [19] and suggested by other authors [24,25].…”

Cerebrospinal Fluid Lactate in Meningitis in Children

“…14 In this study, it was observed that the leucocyte count in the bacterial meningitis was in the range 144 to 7200 cells/mm 3 . No significant correlation was identified between CSF lactate level and CSF leucocytes in bacterial meningitis in this study, whereas in the study by Cabeca H L et al, 15 a positive correlation was found between CSF lactate levels and cellularity in CSF. CSF protein in the bacterial meningitis in this study was in the range of 50-350 mg/dL.…”

Factors associated to the positive cerebrospinal fuid culture in the tuberculous meningitis

“…The lactate is not specific for tuberculous meningitis but is a good marker of cerebral metabolism in bacterial and fungal meningitis. It has no influence of blood concentration, as occurs with the glucose, and is a product of glucose metabolism in CSF 9 . Atypical findings in the CSF such as a concentration of neutrophils and normal exam results may contribute to making the diagnosis more difficult 7 .…”