Predictive Value of Cerebrospinal Fluid Lactate Level for the Diagnosis of Bacterial Meningitis following Cranial Surgery

Background:To distinguish post-neurosurgical bacterial meningitis (PNBM) from aseptic meningitis is difficult. Inflammatory and biochemical cerebrospinal fluid (CSF) changes mimic those classically observed after CNS surgery. CSF lactate assay has therefore been proposed as a useful PNBM marker. Objective:To determine the value of cerebrospinal fluid (CSF) lactate level for the identification of bacterial meningitis following cranial surgery. Methods:Between January 2016 and December 2016, a prospective clinical study was done in Department of Neurosurgery, in which all patients with clinical suspicion of PNBM were enrolled. Patients with clinical suspicion of bacterial meningitis BM were categorized, according to preset criteria, into 3 groups: (1) proven BM; (2) presumed BM, and (3) nonbacterial meningeal syndrome. CSF markers were plotted in a receiver operating curve (ROC) to evaluate their diagnostic accuracy. Results:The study included 70 patients. We obtained 65 CSF samples from patients with clinical suspicion of BM by CSF analysis. 20 corresponded to proven BM, 7 to probable BM and 38 to excluded BM. Mean lactate in CSF was: 8.4 ±3.0 mmol /l for proven BM, 4.8 ± 0.99 mmol /l for probable BM and 2.08 ± 0.822 mmol/l for excluded BM (P < .001). Conclusion: CSF lactate level has good predictive value to distinguish BM from aseptic meningitis with sensitivity of 90% and specificity: 87% at cut-off value: 4.0 mmol/l.

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Predictive Value of Cerebrospinal Fluid (CSF) Lactate Level Versus CSF/Blood Glucose Ratio for the Diagnosis of Bacterial Meningitis Following Neurosurgery

Clinical Infectious Diseases ◽

10.1086/520184 ◽

1999 ◽

Vol 29 (1) ◽

pp. 69-74 ◽

Cited By ~ 105

Author(s):

Stephen L. Leib ◽

Remy Boscacci ◽

Othmar Gratzl ◽

Werner Zimmerli

Keyword(s):

Cerebrospinal Fluid ◽

Blood Glucose ◽

Bacterial Meningitis ◽

Predictive Value ◽

Lactate Level ◽

Glucose Ratio ◽

Level Versus ◽

Csf Lactate

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

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.7.1682 ◽

2020 ◽

Vol 36 (7) ◽

Author(s):

Hina Nasir ◽

Muhammad Faheem Afzal ◽

Muhammad Haroon Hamid ◽

Akmal Laeeq

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Lactate Level ◽

Acute Bacterial Meningitis ◽

Csf Lactate ◽

Meningitis In Children ◽

Sensitivity Specificity

Objective: To determine the diagnostic accuracy of cerebrospinal fluid lactate level in confirmed cases of acute bacterial meningitis in children Methods: 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. doi: https://doi.org/10.12669/pjms.36.7.1682 How to cite this:Nasir H Afzal MF, Hamid MH, Laeeq A. Diagnostic accuracy of cerebrospinal fluid lactate in confirmed cases of acute bacterial meningitis in children. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.1682 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Predictive value of cerebrospinal fluid lactate for the diagnosis and treatment efficacy of post-neurosurgery bacterial meningitis

10.21203/rs.2.18481/v1 ◽

2019 ◽

Author(s):

Yufang Wang ◽

Jingchao Li ◽

Mingli Yao ◽

Lingyan Wang ◽

Bin Ouyang

Keyword(s):

Cerebrospinal Fluid ◽

Linear Regression ◽

Bacterial Meningitis ◽

Roc Curve ◽

Predictive Value ◽

Treatment Efficacy ◽

Curve Analysis ◽

Diagnosis And Treatment ◽

Roc Curve Analysis ◽

Csf Lactate

Abstract Background: Post-neurosurgical bacterial meningitis (PNBM) is a severe complication with high morbidity and mortality. Rapid and accurate diagnosis of PNBM is difficult. Therefore, it is necessary to find more reliable markers to assist the diagnosis. This study aims to evaluate the predictive value of cerebrospinal fluid (CSF) lactate for PNBM diagnosis and treatment efficacy.Methods: Total 105 cases were enrolled in patients with clinically suspected PNBM who underwent neurosurgeries during October 2015 to December 2016. CSF lactate as well as CSF routine and biochemistry test was measured. Receivers operating characteristic (ROC) curve analysis was used to evaluate the diagnostie power of CSF lactate for PNBM. To assess the predictive value of CSF lactate for treatment efficacy, a linear regression was used and tendency diagrams of CSF lactate and glucose for each patient were drawn.Results: Fifty-four of 105 patients were diagnosed with PNBM. CSF lactate level was significantly higher in PNBM than in non-PNBM patients (p < 0.001). The ROC curve analysis showed a great diagnostic power of CSF lactate for PNBM, and the cut-off value was 4.15 mmol/L (AUC = 0.92, sensitivity, 92.6%; specificity, 74.5%). The combination of CSF lactate and glucose showed better diagnostic efficacy (AUC = 0.97, sensitivity, 94.4%; specificity, 90.2%). The linear regression showed thatΔCSF lactate inversely correlated with ΔCSF glucose and directly correlated with ΔCSF leucocyte (both p < 0.001). The tendency diagrams showed CSF lactate a better predictor for PNBM treatment efficacy than CSF glucose.Conclusion: Our study showed CSF lactate had an excellent discriminatory power in distinguishing between PNBM and non-PNBM. The combination of CSF lactate and glucose had a better diagnostic accuracy than other CSF parameters alone. CSF lactate was a reliable predictor of treatment efficacy in PNBM patients.

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Evaluating the diagnostic accuracy of gene xpert analysis in pediatric pulmonary tuberculosis: a prospective clinical study in North-Western India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20211083 ◽

2021 ◽

Vol 8 (4) ◽

pp. 716

Author(s):

Venkatesh Karthik S. ◽

Jigisha Patadiya

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Roc Analysis ◽

Gastric Lavage ◽

Control Program ◽

Tuberculin Test ◽

Receiver Operating Curve ◽

Prospective Clinical Study ◽

Western India ◽

X Rays

Background: The diagnosis of tuberculosis (TB) by microbiological tests is a major challenge particularly in children. The use of Xpert analysis, a rapid genetic testing modality is not widely reported in our locality. The aim of the study to evaluate the diagnostic accuracy of Gene xpert analysis in diagnosis of pediatric Pulmonary TB.Methods: A prospective hospital-based study was conducted among 140 participants with symptomatology pertaining to pulmonary TB as per Revised national tuberculosis control program (RNTCP, India) criteria. The Xpert testing (GXT) was performed as per standards and was compared with erythrocyte sedimentation rate (ESR), tuberculin test (TT) and chest X-rays (CXR). The obtained results were reported in terms of Sensitivity %, Specificity %, Positive Predictive Value % (PPV) and Negative Predictive Value % (NPV) for comparisons. The receiver operating curve (ROC) analysis was employed to evaluate the accuracy of diagnosis.Results: The GXT was positive (10.71 %) in suspected TB patients. TT has significantly (10 %) with a73.33% sensitivity, 93.60% specificity and a PPV of 57.89 % when compared with xpert. The ESR showed a sensitivity of 53.33% and a specificity of 56%. The CXR showed sensitivity of 93.33%. The ROC analysis showed that TT had a higher confidence interval (0.699-0.970) t5`han other methods. The Rifampicin resistance was found 7.5% (n=2) of 15 GXT positive cases.Conclusions: The xpert based diagnosis of gastric lavage samples after a tuberculin test (TT) had high sensitivity and specificity, followed by chest X ray while the ESR had lower clinical accuracy. The ‘gene xpert analysis’ is highly useful rapid tool for diagnosis of children with TB.

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Correlation between Neopterin, Biopterin and Nitrite/Nitrate in Cerebrospinal Fluid in Child Patients with Neurological Diseases

Pteridines ◽

10.1515/pteridines.2003.14.1.5 ◽

2003 ◽

Vol 14 (1) ◽

pp. 5-8

Author(s):

Yasuhiko Kawakami ◽

Mayuko Sakamoto ◽

Ken-ichi Shimada ◽

Eiji Noguchi ◽

Kentaro Kuwabara ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Aseptic Meningitis ◽

Neurological Diseases ◽

Febrile Convulsions ◽

Child Patients ◽

Nitrite Nitrate

Abstract Cerebrospinal fluid (CSF) neopterin been previously reported in various diseases. In this study CSF neopterin, biopterin, and nitrite/nitrate (NOx) Contents were measured and the correlation between them in child patients with various kinds of neurological diseases were investigated. Changes in the CSF neopterin levels in patients with bacterial meningitis were similar to those previously reported for those with bacterial meningitis; on the 2th hospital day they were significantly higher than on admission, and on the 6th hospital day they were tapered. The CSF biopterin levels and CSF NOx content in patients with bacterial meningitis on admission were significantly higher than those with other categories and were decreased gradually. Although patients with high levels of CSF neopterin tended to have high CSF biopterin levels in any categories, there was no significant correlation between CSF neopterin and biopterin levels. The CSF biopterin and NOx levels in patients with convulsions were higher than those with aseptic meningitis. Since the neuro-protective or anticonvulsant role for NO was previously reported, high CSF biopterin and NOx levels in patients having epilepsy or febrile convulsions may be regarded as one of the endogenous mechanisms for recovery from an overexcitatory brain in patients with convulsive diseases.

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Phosphatidylcholine PC ae C44:6 in cerebrospinal fluid is a sensitive biomarker for bacterial meningitis

Journal of Translational Medicine ◽

10.1186/s12967-019-02179-w ◽

2020 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Leonardo Silva de Araujo ◽

Kevin Pessler ◽

Kurt-Wolfram Sühs ◽

Natalia Novoselova ◽

Frank Klawonn ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Cell Count ◽

Negative Predictive Value ◽

Predictive Value ◽

Characteristic Curve ◽

Viral Meningitis ◽

Acute Bacterial Meningitis ◽

Membrane Phospholipids ◽

Cns Disorders

Abstract Background The timely diagnosis of bacterial meningitis is of utmost importance due to the need to institute antibiotic treatment as early as possible. Moreover, the differentiation from other causes of meningitis/encephalitis is critical because of differences in management such as the need for antiviral or immunosuppressive treatments. Considering our previously reported association between free membrane phospholipids in cerebrospinal fluid (CSF) and CNS involvement in neuroinfections we evaluated phosphatidylcholine PC ae C44:6, an integral constituent of cell membranes, as diagnostic biomarker for bacterial meningitis. Methods We used tandem mass spectrometry to measure concentrations of PC ae C44:6 in cell-free CSF samples (n = 221) from patients with acute bacterial meningitis, neuroborreliosis, viral meningitis/encephalitis (herpes simplex virus, varicella zoster virus, enteroviruses), autoimmune neuroinflammation (anti-NMDA-receptor autoimmune encephalitis, multiple sclerosis), facial nerve and segmental herpes zoster (shingles), and noninflammatory CNS disorders (Bell’s palsy, Tourette syndrome, normal pressure hydrocephalus). Results PC ae C44:6 concentrations were significantly higher in bacterial meningitis than in all other diagnostic groups, and were higher in patients with a classic bacterial meningitis pathogen (e.g. Streptococcus pneumoniae, Neisseria meningitidis, Staphylococcus aureus) than in those with less virulent or opportunistic pathogens as causative agents (P = 0.026). PC ae C44:6 concentrations were only moderately associated with CSF cell count (Spearman’s ρ = 0.45; P = 0.009), indicating that they do not merely reflect neuroinflammation. In receiver operating characteristic curve analysis, PC ae C44:6 equaled CSF cell count in the ability to distinguish bacterial meningitis from viral meningitis/encephalitis and autoimmune CNS disorders (AUC 0.93 both), but had higher sensitivity (91% vs. 41%) and negative predictive value (98% vs. 89%). A diagnostic algorithm comprising cell count, lactate and PC ae C44:6 had a sensitivity of 97% (specificity 87%) and negative predictive value of 99% (positive predictive value 61%) and correctly diagnosed three of four bacterial meningitis samples that were misclassified by cell count and lactate due to low values not suggestive of bacterial meningitis. Conclusions Increased CSF PC ae C44:6 concentrations in bacterial meningitis likely reflect ongoing CNS cell membrane stress or damage and have potential as additional, sensitive biomarker to diagnose bacterial meningitis in patients with less pronounced neuroinflammation.

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Comparison of enterovirus detection in cerebrospinal fluid with Bacterial Meningitis Score in children

Einstein (São Paulo) ◽

10.1590/s1679-45082017ao3880 ◽

2017 ◽

Vol 15 (2) ◽

pp. 167-172 ◽

Cited By ~ 4

Author(s):

Frederico Ribeiro Pires ◽

Andréia Christine Bonotto Farias Franco ◽

Alfredo Elias Gilio ◽

Eduardo Juan Troster

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Aseptic Meningitis ◽

Medical Records ◽

Pediatric Patients ◽

Tertiary Hospital ◽

Viral Meningitis ◽

Parenteral Antibiotic ◽

Score Analysis

ABSTRACT Objective To measure the role of enterovirus detection in cerebrospinal fluid compared with the Bacterial Meningitis Score in children with meningitis. Methods A retrospective cohort based on analysis of medical records of pediatric patients diagnosed as meningitis, seen at a private and tertiary hospital in São Paulo, Brazil, between 2011 and 2014. Excluded were patients with critical illness, purpura, ventricular shunt or recent neurosurgery, immunosuppression, concomitant bacterial infection requiring parenteral antibiotic therapy, and those who received antibiotics 72 hours before lumbar puncture. Results The study included 503 patients. Sixty-four patients were excluded and 94 were not submitted to all tests for analysis. Of the remaining 345 patients, 7 were in the Bacterial Meningitis Group and 338 in the Aseptic Meningitis Group. There was no statistical difference between the groups. In the Bacterial Meningitis Score analysis, of the 338 patients with possible aseptic meningitis (negative cultures), 121 of them had one or more points in the Bacterial Meningitis Score, with sensitivity of 100%, specificity of 64.2%, and negative predictive value of 100%. Of the 121 patients with positive Bacterial Meningitis Score, 71% (86 patients) had a positive enterovirus detection in cerebrospinal fluid. Conclusion Enterovirus detection in cerebrospinal fluid was effective to differentiate bacterial from viral meningitis. When the test was analyzed together with the Bacterial Meningitis Score, specificity was higher when compared to Bacterial Meningitis Score alone.

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Comparative analysis of cerebrospinal fluid adenosine deaminase levels in infective meningitis of different aetiologies

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20170718 ◽

2017 ◽

Vol 4 (2) ◽

pp. 608

Author(s):

Mohsin Rashid ◽

Sheikh Mushtaq ◽

Junaid Manzoor ◽

Javaid Ahmad Bhat ◽

Shilakha Chaman ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Diagnostic Accuracy ◽

Adenosine Deaminase ◽

Aseptic Meningitis ◽

Predictive Value ◽

Cost Effective ◽

Systemic Lupus Erythematosis ◽

Pyogenic Meningitis ◽

Tubercular Meningitis ◽

High Level

Background: Meningitis can be caused by bacteria, viruses, parasites, and fungi as well as by non-infectious conditions including inflammatory disorders (e.g., systemic lupus erythematosis or Kawasaki disease) and neoplasia (e.g., leukemic meningitis). The objective of this study were to study cerebrospinal fluid (CSF) adenosine deaminase (ADA) levels in infective meningitis of different aetiologies. And to assess the role of cerebrospinal fluids (CSF) adenosine deaminase (ADA) levels in differentiating tubercular from non-tubercular meningitis.Methods: The study was conducted on 70 patients of meningitis at Postgraduate Department of Paediatrics, in G. B. Pant Hospital, an associated hospital of Government Medical College Srinagar. Out of 70 patients included in the study 27 cases were Aseptic Meningitis (AM), 14 cases partially treated pyogenic -meningitis (PTM), 19 cases pyogenic meningitis (PM), and 10 cases were tubercular meningitis (TBM). ADA activity of CSF was quantified by colorimetry.Results: In our study we observed a significant high level of ADA 30.0±3.2U/L (20.0, 54.0) among the tubercular meningitis (TBM) patients and its respective level among Aseptic Meningitis (AM), was 8.1±0.3U/L (4.0, 11.5), partially treated pyo -meningitis (PTM) was 7.6±0.4U/L (5.0, 11.0), pyogenic meningitis (PM) was 11.6±0.5U/L (8.0, 14.5). In total Non-TBM ADA level was 9.1±0.3U/L (4.0, 14.5) units/liter. At cut off of > or equal to 10U/L sensitivity was 100% specificity66.67% positive predictive value33.33% negative predictive value of 100% diagnostic accuracy 71.43%. At a higher cut off of > or equal to 12U/L sensitivity was 100% and specificity increased to 81.67% positive predictive value 47.62% negative predictive value100% diagnostic accuracy was 84.29%.Conclusions: The sensitivity and specificity of CSF ADA activity is markedly high in differentiating TBM from non-TBM. Hence CSF ADA activity may be used as a simple, cost-effective and reliable test for early diagnosis of TBM.

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Comparison of cerebrospinal fluid lactate with physical, cytological, and other biochemical characteristics as prognostic factors in acute bacterial meningitis

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20190185 ◽

2019 ◽

Vol 77 (12) ◽

pp. 871-880

Author(s):

Sérgio Monteiro De Almeida ◽

Nagyla C. Barros ◽

Ricardo Petterle ◽

Keite Nogueira

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Lactate Concentration ◽

Good Prognosis ◽

Acute Bacterial Meningitis ◽

Csf Biomarkers ◽

High Morbidity ◽

Initial Hypothesis ◽

Csf Lactate ◽

Lactate Levels

ABSTRACT Bacterial meningitis (BM) is associated with a high morbidity and mortality. Cerebrospinal fluid (CSF) lactate may be used as a prognostic marker of this condition. We hypothesized that CSF lactate levels would remain elevated in participants who died of acute BM compared with those who recovered from this disease. Objective: To evaluate the potential use of lactate and other CSF biomarkers as prognostic markers of acute BM outcome. Methods: This retrospective, longitudinal study evaluated dynamic CSF biomarkers in 223 CSF samples from 49 patients who fulfilled the inclusion criteria of acute BM, with bacteria identified by CSF culturing. The participants were grouped according to outcome: death (n = 9; 18.37%) and survival (n = 40; 81.63%). All participants received appropriate antibiotic treatment. Results: In the logistic regression model, lactate concentration in the final CSF sample, xanthochromia, and CSF glucose variation between the first and last CSF samples were predictors of a poor outcome (death). In contrast, decrease in CSF white blood cell count and CSF percentage of neutrophils, increase in the percentage of lymphocytes, and normalization of the CSF lactate concentration in the last CSF sample were predictors of a good prognosis. Conclusion: The study confirmed the initial hypothesis. The longitudinal analysis of CSF lactate is an important predictor of prognosis in acute BM.

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