Utilização De Escore E Dosagem De Lactato No Líquor Para Diagnóstico Diferencial Entre Meningite Bacteriana E Meningite Asséptica

Abstract

Objective: To evaluate Bacterial Meningitis Score (BMS) on its own and in association with Cerebrospinal Fluid (CSF) lactate dosage in order to distinguish bacterial from aseptic meningitis.Methods: Children diagnosed with meningitis at a tertiary hospital between January/2011 and December/2014 were selected. All data were obtained upon admission. BMS was applied and included: CSF Gram staining (2 points); CSF neutrophil count ≥1,000 cells/mm3 (1 point); CSF protein ≥80 mg/dL (1 point); peripheral blood neutrophil count ≥10,000 cells/mm3 (1 point) and seizures upon/before arrival (1 point). Cutoff value for CSF lactate was ≥30 mg/dL. Sensitivity, specificity and negative predictive value of several BMS cutoffs and BMS associated with high CSF lactate were evaluated for prediction of bacterial meningitis.Results: Among 439 eligible patients, 94 did not have all data available to complete the score, and 345 patients were included: 7 in bacterial meningitis group and 338 in aseptic meningitis group. As predictive factors of bacterial meningitis, BMS ≥1 had 100% sensitivity (95%CI 47.3-100), 64.2% specificity (58.8-100) and 100% negative predictive value (97.5-100); BMS ≥2 or BMS ≥1 associated with high CSF lactate also showed 100% sensitivity (47.3-100); but 98.5% specificity (96.6-99.5) and 100% negative predictive value (98.3-100).Conclusions: 2 point BMS in association with CSF lactate dosage had the same sensitivity and negative predictive value, with increased specificity for diagnosis of bacterial meningitis when compared with 1-point BMS.

O perfil clínico do paciente com meningite bacteriana: uma abordagem neurológica

“…A punção lombar, caso não houver contraindicação e a coleta de sangue para cultura devem ser f eitas antes do início da antibioticoterapia (PIRES FR, et al, 2017). O exame sanguíneo é muito solicitado para avaliar o estado geral do paciente, podendo indicar elevação no número de leucócitos e neutróf ilos, além de detectar linf ócitos atípicos e aumento na concentração de PCR no sangue, sendo alto preditor de inf ecção.…”

Incidência dos casos de meningite na cidade de Uberaba, Minas Gerais no período de 2010 a 2017: estudo populacional / Incidence of meningitis in the city of Uberaba / MG from 2010 to 2017: a population study

“…Neste cenário, foi realizado, recentemente, um levantamento em um hospital de clínicas terciário do estado de São Paulo onde foram selecionadas crianças com meningite, atendidas entre janeiro de 2011 e dezembro de 2014 10 . Os dados foram obtidos na admissão.…”

“…Somou-se aos fatores de diagnóstico constituintes do escore tradicional o valor de lactato liquórico. Dos 439 pacientes elegíveis no estudo, 94 não tinham todos os dados necessários para o escore, sendo 345 pacientes selecionados: 7 no grupo de Meningite Bacteriana e 338 no de Meningite Asséptica ou Viral 10 .…”

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

“…other CSF markers to identify bacterial meningitis. Pires et al19 found lactate as the best single CSF marker of bacterial meningitis with high sensitivity and specificity of CSF lactate in a pediatric population. Our findings confirm the findings of previous studies showing CSF lactate as the reliable CSF marker of bacterial meningitis.…”