Estimation Of Csf Lactate As Diagnostic Marker To Differentiate Pyogenic Meningitis From Non-Pyogenic Meningitis

Abstract

Background and objectives Making a differential diagnosis between bacterial meningitis, aseptic meningitis and tubercular meningitis is a critical clinical problem. This study was planned to estimate CSF lactate as diagnostic marker to differentiate pyogenic meningitis from non-pyogenic Meningitis so as to evaluate its accuracy. Methodology This one year cross-sectional study was conducted in the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum from January 2015 to December 2015. A total of 70 patients presenting with meningitis aged more than 18 years were studied. Results Most of the patients were males (68.57%) and male to female ratio was 2:1. Most of the patients were aged between 18 to 40 years (42.85%) followed by 41 to 60 years (32.86%) and > 60 years (24.29%). The mean age was 46.51 ± 18.90 years. Most common clinical presentation was fever noted in 97.14%. Most of the patients has tubercular meningitis (42.86%) followed by viral (37.14%), pyogenic (15.71%) and cryptococcal (4.29%). Majority of the patients had CSF lactate levels of ≤5 mmol/L (78.57%) while lactate levels of 6 to 10 mmol/L, 11 to 15mmol/L and 15 to 20 mmol/L were noted in 8.57%, 8.57% and 4.29% of the patients respectively. The mean CSF lactate levels were 4.66 ± 4.07 mmol/L and median levels were 2.70 mmol/L with range 1 mmol/L being minimum and 16.10 mmol/L being maximum. It was observed that, significantly higher number of patients had raised CSF lactate levels in pyogenic meningitis (p<0.001). The mean CSF lactate levels were significantly high in patients with pyogenic meningitis (12.75 ± 3.46 mmol/L) compared to tubercular (4.11 ± 1.65 mmol/L), cryptococcal (2.93 ± 1.10 mmol/L) and viral (1.98 ± 0.40 mmol/L) (p<0.001). Majority of the patients improved (91.43%) while 8.57% of the patients expired. Conclusion CSF lactate level was significantly high in pyogenic meningitis and it can provide pertinent, rapid and reliable diagnostic information. Furthermore, CSF lactate level can also differentiate pyogenic andfrom non pyogenic meningitis in a quick and better way.