Role of CSF CK, LDH, GGTP Enzyme Levels in Diagnostic and Prognostic Evaluation of Meningitis.

Abstract

Aetiological diagnosis for meningitis remains a challenge and often a thorough Cerebrospinal fluid (CSF) examination may not give a precise diagnosis as at times CSF findings may simulate meningitis like picture as in carcinomatous meningitis, chemical meningitis, early stages of Guillan bare syndrome, subarachnoid hemorrhage, ICSOL, brain abscess, intracranial extension of epidural or subdural infection. Lesions of tissue rich in enzymes may cause enzymatic release on tissue destruction, so also in meningitis and many enzymes are known to be present in abundance in nervous system. To evaluate the diagnostic and prognostic significance of Creatine Kinase (CK), Lactate Dehydrogenase (LDH) and Gamma Glutamyl Transpeptidase (GGTP) enzymes in CSF of meningitis. A prospective cases control study of pyogenic and tubercular meningitis patients of 44 cases admitted in department of medicine from September 2011-September 2012 was done. Enzymes like CK, LDH and GGTP were estimated on day 0 (day of admission) and 7th day in the CSF and in serum. CSF and serum CK, LDH, GGTP was estimated on 0th day 0 only in cases of controls. Out of 44 patients, total 32 were tubercular meningitis and 12 were pyogenic meningitis. Mean CSF CK, LDH levels were significantly raised in both conditions with respect to controls in day 0 with p < 0.0001 and p < 0.05 respectively. Mean CSF CK, LDH level were also significantly reduced from 0 to 7th day in both tubercular, pyogenic meningitis, while CSF GGTP was not significantly raised with respect to control in day 0. Enzymes level in CSF like CK, LDH are significantly raised in the meningitis and accessing its value can be an important diagnostic and prognostic marker. But more studies are required to establish the usefulness of estimating these enzymes.