Lactic Acid of Spinal Fluid in Meningitis

Abstract

In 1926,1 one of us (Dr. Killian) and his associate reported that spinal fluid from cases of meningitis showed unusually high values for lactic acid and low ones for sugar. The source of the increased lactic acid appeared to lie in the metabolic activity of the leukocytes. These studies were continued, and in 1928 2 we came to the conclusion that the changes in lactic acid concentration were a better index of the progress of the infection than the changes in the sugar content. In meningitis the lactic acid of the spinal fluid was greater than that of the blood, but the sugar of the spinal fluid was less than that of the blood. Furthermore, the lactic acid of the spinal fluid may fluctuate within a wide range, although the amount of sugar remains normal. Since our first observations, similar studies have been reported by others.3 In the recent paper by Wright, Herr and Paul 4 on the spinal fluid in suppurative meningitis, an excellent review on this subject is found, and it is therefore unnecessary to repeat such a summary here.In the present report we wish to add further evidence to support the original conclusions and to enlarge on their significance. An intensive study of the sugar, lactic acid and cell count of the spinal fluid in various types of meningitis was made in order to determine whether the lactic acid varies with the cell count and whether it may be utilized as an index of the progress of the infection or of the From the

Cerebrospinal fluid lactate in post-neurosurgical bacterial meningitis diagnosis

“…To the best of our knowledge, this is the largest prospective study on the use of CSF lactate to discriminate between PNBM and other inflammatory CSF conditions. CSF acidosis due to bacterial infection has been known for a long time [12][13][14], and CSF lactate has been available circa 1920. However, despite its use in the pediatric population to differentiate between bacterial and viral meningitis [11,20], the use of CSF lactate in the adult population has been limited because of the availability of the test and questions that arose regarding its utility [2].…”

“…CSF lactic acid has been proposed as a potential marker distinguishing between infection and inflammation [11]. When CSF infection is present, leukocytes increase anaerobic glucose metabolism, thus producing lactic acid and lowering pH [11][12][13][14][15]. Bacterial metabolism, neutrophil glycolysis and anaerobic metabolism of brain tissue during bacterial meningitis lead to CSF lactate accumulation [16].…”

“…Lactate slowly crosses the blood-brain barrier and has decreased CSF clearance, consequently representing a useful indicator of brain metabolism [17]. CSF lactate is used to distinguish bacterial from viral meningitis in children (discriminatory threshold between 3.5 and 4 mmol/L [11][12][13][14][15][16][17][18][19]), as well as to discriminate between types of inflammatory response, demonstrating good correlation with infection in several retrospective series [7][8][9][10]. In a retrospective study, Leib et al [2] have evaluated glucose CSF:blood ratio and CSF lactate levels in neurosurgical patients for proven or probable PNBM vs. no meningitis diagnosis.…”

Predictive Value of Cerebrospinal Fluid (CSF) Lactate Level Versus CSF/Blood Glucose Ratio for the Diagnosis of Bacterial Meningitis Following Neurosurgery

“…[28] recognized in 1925 that BM lowered the CSF glucose concentration and elevated the CSF lactate level, and in 1933 De Sanctis et al [29] reported that for the diagnosis of bacterial meningitis, an increased CSF lactate level is more reliable than a decreased CSF glucose level. Since then, many studies on spontaneously occurring BM have confirmed and refined these initial observations [6, 9 -11, 22, 23].…”

Neonatal Meningitis: Overcoming Challenges in Diagnosis, Prognosis, and Treatment with Omics

“…While approaches to simultaneously evaluate multitudes of metabolites have become available only recently, metabolic analysis of CSF is nearly a century old (76). Consistent with presumed cellular stress and high metabolic demand, elevated levels of lactate and decreased levels of glucose were among the first markers to be associated with meningitis.…”