Role of cerebro spinal fluid lactate as a diagnostic marker for differentiation from bacterial and aseptic meningitis

Abstract

Background: Meningitis is serious and a life threatening condition among any age group associated with serious mortality and morbidity. CSF lactate may be a good marker to differentiate bacterial from other cause of meningitis. Objective of this study is to evaluate the efficiency of CSF lactate in differentiating bacterial/ pyogenic from non pyogenic meningitis.Methods: A one year prospective study with all cases diagnosed as meningitis was enrolled and CSF analysis was done. Patients were grouped as bacteria, viral and tubercular meningitis based on clinical and CSF analysis. All cytological, biochemical and CSF lactate were estimated and compared with lactate to differentiate pyogenic from non pyogenic meningitis. Statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 20.Results: A total of 120 cases with 74 males and 46 females, majority in 31-50 years age group were included. 59 pyogenic, 37 tubercular and 24 viral meningitis cases were diagnosed. Fever was common symptom (91.67%). Mean CSF protein was highest in pyogenic meningitis (271.1±142.28), 26 cases of tubercular meningitis demonstrated elevated levels of CSF lactate with a cut-off value of >2.1mmol/l (70.27%), five cases of viral meningitis (13.51%) and all 59 cases of pyogenic meningitis (100%).Conclusions: This present study concludes that CSF lactate could be a reliable and valid marker in early differentiation of pyogenic from cases of nonpyogenic meningitis. Early detection may help in early decision on the type and institution of appropriate management could reduce the mortality and morbidity of meningitis.