Clinical study of CSF lactate as a diagnostic marker to differentiate pyogenic meningitis from nonpyogenic meningitis at tertiary health care center

 

 

Abstract              Background: The magnitude of this problem can be understood from the fact that over 1.2 million cases of bacterial meningitis are estimated to occur worldwide each year. Without treatment, the case-fatality rate can be as high as 70 percent, and one in five survivors of bacterial meningitis may be left with permanent sequel including hearing loss, neurologic disability, or loss of a limb. CSF lactate is produced by anaerobic metabolism and its level increases in any condition which causes decrease in oxygen supply to the brain. The diagnostic value of CSF lactate lies in the identification of untreated and partially treated bacterial meningitis. Present study was undertaken to determine the usefulness of CSF lactate as a diagnostic marker to differentiate pyogenic meningitis from nonpyogenic meningitis at tertiary health care center. Material and Methods: This prospective, observational study was conducted in department of Internal medicine in patients age > 18 years with fever, headache and signs of meningeal irritation with or without seizures and depressed level of consciousness. Results: In present study total 54 patients fulfilled inclusion and exclusion criteria. Most of the patients were above 50 years age group (48 %), age group 51-60 was most common age group. Male patients (59 %) were more than female patients (41 %). Male to female ratio was 1.25 :1. Fever, headache and altered sensorium were the most common presenting symptoms and majority of patients had signs of meningeal irritation. Most number of cases were pyogenic meningitis (56 %) while 44% were of non-pyogenic meningitis. The mean value of CSF lactate in pyogenic meningitis group were higher than non-pyogenic meningitis (136.51 ± 41.14 mg/dL vs. 34.18 ± 10.21 mg/dL). Statistically CSF lactate levels were significantly increased in pyogenic meningitis cases when compared to CSF lactate levels in non-pyogenic meningitis patients. Conclusion: CSF lactate level is markedly elevated in pyogenic meningitis as compared to non-pyogenic meningitis and it can be used to distinguish pyogenic meningitis from non-pyogenic meningitis.

Keywords: pyogenicmeningitis, pyogenic meningitis, CSF lactate.