The Value of Combined Measuring of the Cerebrospinal Fluid Lactate and ‎Serum Procalcitonin in Diagnosis of Acute Bacterial Meningitis ‎

Hosam Dawod,Seham Mahrous,Sameh Abdel Monem,Ahmed Awadallah,Ahmed Alwassief

doi:10.21608/aeji.2021.71520.1143

Abstract

Backgroundand study aim:The differential diagnosis between bacterial meningitis and aseptic meningitis is a critical clinical issue and ‎searching for reliable and valid markers is required. This work aimed to assess the role of the combined ‎measuring of CSF lactate and serum procalcitonin in the diagnosis of acute bacterial meningitis‎‎‎. Patients and Method:‎A cross-sectional study including 42 meningitis patients was conducted at Zagazig Fever Hospital and Zagazig ‎University Hospitals in the period from November 2018 to June 2019, Patients were divided according to their ‎final diagnosis into two groups; group I included 13 patients with bacterial meningitis ( positive CSF bacterial ‎culture and/or Gram stain ), group II included 29 patients with aseptic meningitis (negative CSF bacterial ‎culture and Gram stain), The data collection sheet included clinical assessments, lumbar puncture with CSF ‎analysis, CSF lactate level testing, and Serum procalcitonin level testing‎‎.‎ Results: One hundred five of house officer participated Serum procalcitonin and CSF lactate levels were significantly higher in the bacterial meningitis group (1.16 ‎‎±1.24, 7.5 ± 6.6, respectively) than patients with aseptic meningitis (0.059 ± 0.04, 3.98 ± 2.1, respectively). ‎The measuring of both serum procalcitonin and CSF lactate levels had got a higher sensitivity, specificity, and ‎accuracy (96.6%, 76.9%, 90.9% respectively) for the diagnosis of bacterial meningitis more than measuring ‎either of them only‎‎‎. Conclusion: The combined measuring of both serum procalcitonin and CSF lactate levels is highly accurate in the diagnosis ‎of bacterial meningitis cases and helps to differentiate bacterial meningitis from aseptic meningitis‎‎‎‎.

Highlights

Bacterial meningitis is an inflammation of the meninges due to bacterial infection and represents one of the endemic diseases in Egypt [1,2]
The isolated bacteria included Neisseria meningitidis in 7 cases, Streptococcus Pneumoniae in 3 cases, Haemophilus influenzae in 2 cases, Escherichia coli in one case
Serum PCT and CSF lactate levels were significantly higher in the bacterial meningitis group (1.16 ±1.24, 7.5 ± 6.6, respectively) than patients with aseptic meningitis (0.059 ± 0.04, 3.98 ± 2.1, respectively)

Summary

Introduction

Bacterial meningitis is an inflammation of the meninges due to bacterial infection and represents one of the endemic diseases in Egypt [1,2]. Aseptic meningitis is an inflammation of meninges without evidence of bacterial infection on bacterial cultures and Gram staining. It is usually accompanied by a mononuclear pleocytosis [3].The commonest cause of bacterial meningitis is Neisseria meningitidis, Haemophilus influenzae type b, Streptococcus pneumoniae [4], while the common cause of aseptic meningitis is viral meningitis [5]. Positive CSF bacterial culture and Gram staining are considered the gold standard in the diagnosis of bacterial meningitis. They have poor sensitivity and the bacterial culture is timeconsuming [7]

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