Role of cerebrospinal fluid, creatine kinase and lactate dehydrogenase enzyme levels in diagnostic and prognostic evaluation of tubercular and pyogenic meningitis

Abstract

Background: Etiological diagnosis for meningitis remains a challenge and often a cerebrospinal fluid (CSF) examination may not give the precise diagnosis. Many enzymes are known to be present in abundance in nervous system. In meningitis, nerve tissue damage leads to release of these enzymes into CSF, which may have important diagnostic and prognostic role. Aim was to evaluate the diagnostic and prognostic significance of creatine kinase (CK) and lactate dehydrogenase (LDH) enzymes in CSF of tubercular and pyogenic meningitis.Methods: A prospective case control study of 50 subjects with pyogenic or tubercular meningitis, admitted in Department of Medicine, S.R.N. Hospital, M.L.N.M.C. Allahabad, Uttar Pradesh, India from September 2015-August 2016 was done. Level of CK and LDH were estimated in CSF and serum on day of admission and 7th day. 50 subjects with non-neurological diseases were taken as control.Results: Out of total 50 patients, 36 were of tubercular meningitis and 14 were of pyogenic meningitis. Mean CSF CK and CSF LDH levels were significantly raised in both conditions with respect to controls (p<0.001 and p<0.05 respectively). Mean CSF CK and CSF LDH level were significantly reduced from day of admission to 7th day in both tubercular and pyogenic meningitis patients.Conclusions: Enzymes level in CSF like CK and LDH are significantly raised in pyogenic and tubercular meningitis. Accessing its value can be an important diagnostic and prognostic marker.