Determination of lactate in cerebral spinal fluid in children with meningitis. A study of 24 cases

Abstract

Objective: To evaluate the diangostic use of cerebrospinal (CSF) lactate determination in the early detection of bacterial meningitis.
Methods: A study was performed to analyse 154 CSF samples from 124 children with criteria for meningitis (range of age 1 month-9 years 8 months). The patients were divided into 4 groups: control group (n=59), viral meningitis (n=17), aseptic meningitis (n=29) and bacterial meningitis (n=19). Cerebrospinal fluid lactate was determined using an enzimatic method. The CSF lactate levels were measures in mmol/L.
Results: The CSF lactate levels in the differente patient groups were: controls (1,39±0,24), viral meningitis (1,5±0,41), aseptic meningitis (1,93±0,41) and bacterial meningitis (7,54±4,2 ). There were found stadistically significant differences between the viral and bacterial meningitis groups (p< 0,01. 10-3) and no stadistically significant differences between the viral and aseptic meningitis groups. A positive correlation was identified between protein and lactate leveles (R2= 0,71; p< 0,01). The cut off for viral and bacterial meningitis differentiation was established by values ? 2,7 mmol/L with a sensitivity of 84%, specifitity of 100% and positive predictive value of 100%.
Conclusions: The determination of lactate in CSF was the most accurate diagnostic test in bacterial meningitis in contrast to the rest of habitual methods like cell counts or glucose, protein and cloride determinations. We propose therefore the introduction of routine CSF lactate analyses in children with meningitis suspicion.