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

Hina Nasir,Akmal Laeeq,Muhammad Faheem Afzal,Muhammad Haroon Hamid

doi:10.12669/pjms.36.7.1682

Abstract

Objective:To determine the diagnostic accuracy of cerebrospinal fluid lactate level in confirmed cases of acute bacterial meningitis in childrenMethods:This cross sectional study was conducted in the Department of Paediatrics, King Edward Medical University/ Mayo Hospital, Lahore from January to December 2018. A total of 250 children, between two months - 12 years of age, of both the genders, with suspected acute bacterial meningitis were included by non-probability consecutive sampling. Each child was subjected to lumbar puncture for biochemistry, cytology, culture, and lactate level. CSF lactate level of 1.1-2.4 mmol/L was taken as normal, and >2.4 mmol/L was taken as cut off for acute bacterial meningitis. All collected data was entered and analyzed in SPSS version 22. A 2 x 2 table was made to calculate diagnostic accuracy, sensitivity, specificity, positive and negative predictive value for CSF Lactate.Results:The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CSF lactate taking CSF culture as gold standard was 100%, 60.61%, 17.27%, 100% and 63.6% respectively, with kappa of 0.19 and p value of 0.000.Conclusion:At a cut off value of 2.4 mmol/L, cerebrospinal fluid lactate level has a high diagnostic accuracy for acute bacterial meningitis.

Highlights

Acute bacterial meningitis (ABM), inflammatory disease of the leptomeninges causing characteristic1
12 (4.8%) cases were of Streptococcus pneumoniae while 7(2.8%) cases were of Neisseria meningitides
The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of cerebrospinal fluid (CSF) lactate taking CSF culture as gold standard was 100% (95% confidence interval (CI) 83.18-100%), 60.61%, 17.27%, 100%, and 63.6% respectively

Summary

Introduction

Acute bacterial meningitis (ABM), inflammatory disease of the leptomeninges causing characteristic1. Acute bacterial meningitis (ABM), inflammatory disease of the leptomeninges causing characteristic. 2. Dr Muhammad Faheem Afzal, FCPS, MHPE. Correspondence: September 19, 2019 November 15, 2019 May 12, 2020 May 20, 2020 changes in the cerebrospinal fluid (CSF), is one of the most common central nervous system infections in Pediatric population. Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis are the most common causative organisms in children more than two months of age.[1] The median incidence for bacterial meningitis is 34.0 per 100,000 child-years globally, with a median casefatality rate of 14.4%.2. Bacteria and enteroviruses are the main cause of acute community-acquired meningitis. Bacterial meningitis is associated with high morbidity and mortality.[3] Prompt treatment with appropriate antibiotics is essential to optimize outcomes. The course of viral meningitis is in general benign and there is usually no specific treatment.[4]

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Conclusion