Abstract
A prospective study to determine the value of cerebrospinal fluid analysis in the differential diagnosis of meningitis was performed in 710 consecutively observed patients, both children and adults, who underwent lumbar puncture due to suspected central nervous system infection. Diagnoses included acute or presumed bacterial meningitis (n=79), acute or presumed viral meningoencephalitis (n=218), acute unclassified meningitis (n=6), other infections of the central nervous system (n=37), non-infectious neurological diseases (n=76) and control patients (n=294). The sensitivity, specificity and predictive values were determined for cerebrospinal fluid white blood cell count, total protein, lactate, glucose and C-reactive protein levels as well as the blood/cerebrospinal fluid glucose ratio. Determination of cerebrospinal fluid levels of lactate (≥ 3.5 mmol/l) was found to be superior to the other tests. The C-reactive protein level gave no additional diagnostic information when the lactate level was determined. The white blood cell count, and total protein and glucose levels were often unreliable tools for differential diagnosis, largely due to low sensitivity at realistic discriminatory limits. The study confirms that no cerebrospinal fluid test is fully reliable in distinguishing bacterial meningitis from other forms of meningitis.
Similar content being viewed by others
References
Karandanis, D., Schulman, J. A. Recent survey of infectious meningitis in adults: review of laboratory findings in bacterial, tuberculous, and aseptic meningitis. Southern Medical Journal 1976, 69: 449–457.
Geiseler, P. J., Nelson, K. E., Levin, S., Reddi, K. T., Moses, V. K. Community-acquired purulent meningitis: a review of 1,316 cases during the antibiotic era 1954–1976. Reviews of Infectious Diseases 1980, 2: 725–745.
Briem, H. Comparison between cerebrospinal fluid concentrations of glucose, total protein, chloride, lactate, and total amino acids for the differential diagnosis of patients with meningitis. Scandinavian Journal of Infectious Diseases 1983, 15: 277–284.
Nachum, R., Lipsey, A., Siegler, S. E. Rapid detection of gram-negative bacterial meningitis by limulus lysate test. New England Journal of Medicine 1973, 289: 571–577.
Fikrig, S. M., Berkovich, S., Emmett, S. M., Gordon, C. Nitroblue tetrazolium dye test differential diagnosis of meningitis. Journal of Pediatrics 1973, 82: 855–857.
Neches, W., Platt, M. Cerebrospinal fluid LDH in 287 children, including 53 cases of meningitis of bacterial and nonbacterial etiology. Pediatrics 1968, 41: 1097–1103.
Briem, H., Hultman, E. H., Kalin, M. E., Lundbergh, P. R. Increased total concentrations of amino acids in the cerebrospinal fluid of patients with purulent meningitis. Journal of Infectious Diseases 1928, 145: 346–350.
De Sanctis, A., Killian, J. A., Garcia, T. Lactic acid of spinal fluid in meningitis: practical, diagnostic, and prognistic value. American Journal of Diseases of Children 1933, 46: 239–249.
Bland, R. D., Lister, R. C., Ries, J. P. Cerebrospinal fluid lactic acid level and pH in meningitis. Aids in differential diagnosis. American Journal of Diseases of Children 1974, 128: 151–156.
Controni, G., Rodriguez, W., Hicks, J. M., Ficke, M., Ross, S., Friedman, G., Khan, W. Cerebrospinal fluid lactic acid levels in meningitis. Journal of Pediatrics 1977, 91: 379–384.
Ferguson, I. R., Tearle, P. V. Gas liquid chromatography in the rapid diagnosis of meningitis. Journal of Clinical Pathology 1977, 30: 1163–1167.
Brook, I., Brickenll, K. S., Overturf, G. D., Finegold, S. M. Measurement of lactic acid in cerebrospinal fluid of patients with infections of the central nervous system. Journal of Infectious Diseases 1978, 137: 384–390.
Komorowski, R. A., Farmer, S. G., Hansson, G. A., Hause, L. L. Cerebrospinal fluid lactic acid in diagnosis of meningitis. Journal of Clinical Microbiology 1978, 8: 89–92.
Lauwers, S. Lactic-acid concentration in cerebrospinal fluid and differential diagnosis of meningitis. Lancet 1978, ii: 163.
Gästrin, B., Briem, L., Rombo, L. Rapid diagnosis of meningitis with use of selected clinical data and gasliquid chromatographic determination of lactate concentration in cerebrospinal fluid. Journal of Infectious Diseases 1979, 139: 529–533.
Eross, J., Silink, M., Dorman, D. Cerebrospinal fluid lactic acidosis in bacterial meningitis. Archives of Disease in Childhood 1981, 56: 692–698.
Knight, J. A., Dudek, S. M., Haymond, R. E. Early (chemical) diagnosis of bacterial meningitis — cerebrospinal fluid glucose, lactate, and lactate dehydrogenase compared. Clinical Chemistry 1981, 27: 1431–1434.
Donald, P. R., Malan, C., Dykman, J. H. Determination of lactate concentrations in cerebrospinal fluid for rapid diagnosis early in bacterial meningitis. Journal of Infectious Diseases 1982, 145: 287–288.
Corrall, C. J., Pepple, J. M., Moxon, E. R., Hughes, W. T. C-reactive protein in spinal fluid of children with meningitis. Journal of Pediatrics 1981, 99: 365–369.
Pönkä, A., Ojala, K., Teppo, A. M., Weber, T. H. The differential diagnosis of bacterial and aseptic meningitis using cerebrospinal fluid laboratory tests. Infection 1983, 11: 129–131.
Virji, M. A., Diven, W. F., Kelly, R. H. CSF alpha-2-macroglobulin and C-reactive protein as aids to rapid diagnosis of acute bacterial meningitis. Clinica Chimica Acta 1985, 148: 31–37.
Abramson, J. S., Hampton, K. D., Babu, S., Wasilauskas, B. L., Marcon, M. J. The use of C-reactive protein from cerebrospinal fluid for differentiating meningitis from other central nervous system diseases. Journal of Infectious Diseases 1985, 151: 854–858.
Eiden, J., Yolken, R. H. C-reactive protein and limulus amebocyte lysate assay in diagnosis of bacterial meningitis. Journal of Pediatrics 1986, 108: 423–426.
Gray, B. M., Simmons, D. R., Mason, H., Barnum, S., Volanakis, J. E. Quantitative levels of C-reactive protein in cerebrospinal fluid patients with bacterial meningitis and other conditions. Journal of Pediatrics 1986, 108: 665–670.
Lannigan, R., MacDonald, M. A., Marrie, T. J., Haldane, E. V. Evaluation of cerebrospinal fluid lactic levels as an aid in differential diagnosis of bacterial and viral meningitis in adults. Journal of Clinical Microbiology 1980, 11: 324–327.
Rutledge, J., Benjamin, D., Hood, L., Smith, A. Is the CSF lactate measurement useful in the management of children with suspected bacterial meningitis? Journal of Pediatrics 1981, 98: 20–24.
Jordan, G. W., Statland, B., Halsted, C. CSF lactate in diseases of the CNS. Archives of Internal Medicine 1983, 143: 85–87.
Lester, A., Stilbo, I., Bartels, P., Bruun, B. Value of CSF lactate in the differential diagnosis between bacterial meningitis and other diseases with meningeal involvement. Acta Pathologica Microbiologica et Immunologica Scandinavica (B) 1985, 93: 21–25.
Komorowski, R. A., Farmer, S. G., Knox, K. K. Comparison of cerebrospinal fluid C-reactive protein and lactate for diagnosis of meningitis. Journal of Clinical Microbiology 1986, 24: 982–985.
Benjamin, D. R., Opheim, K. E., Brewer, L. Is C-reactive protein useful in the management of children with suspected bacterial meningitis? American Journal of Clinical Pathology 1984, 81: 779–783.
Donald, P. R., Strachan, A. F., Schoeman, J. F., De Beer, F. C. Cerebrospinal fluid C-reactive protein in infective meningitis in childhood. Journal of Laboratory and Clinical Medicine 1985, 106: 424–427.
Hansson, L.-O., Lindquist, L., Linné, T., Sego, E. Quantitation of C-reactive protein in cerebrospinal fluid and serum by zone immunoelectrophoresis assay. Journal of Immunological Methods 1987, 100: 191–195.
Stiernstedt, G. T., Granström, M., Hederstedt, B., Sköldenberg, B. Diagnosis of spirochetal meningitis by enzyme-linked immunosorbent assay and indirect immunofluorescence assay in serum and cerebrospinal fluid. Journal of Clinical Microbiology 1985, 21: 819–825.
Gerhardt, W., Keller, H. Evaluation of test data from clinical studies. Scandinavian Journal of Clinical and Laboratory Investigation 1986, 46: 6–46.
Curtis, G. D. W., Slack, M. P. E., Tompkins, D. S. Cerebrospinal fluid lactate and the diagnosis of meningitis. Journal of Infection 1981, 3: 159–165.
Mandal, B. K., Dunbar, E. M., Hooper, J., Parker, L. How useful is cerebrospinal fluid lactate estimation in differential diagnosis of meningitis? Journal of Infection 1983, 6: 231–237.
Berger, J. P., Fawer, F.: Cerebrospinal fluid lactate and pyruvate in acute neurologic situations. In: Bossart, H., Perret, C. (ed.): Lactate in acute conditions. S. Kager, 1979, p. 115–133.
Sindic, C. J. M., Collet-Cassart, D., Depre, A., Laterre, E. C., Masson, P. L. C-reactive protein in serum and cerebrospinal fluid in various neurological conditions. Journal of the Neurological Sciences 1984, 63: 339–344.
Peltola, H. O. C-reactive protein for rapid monitoring of infections of the central nervous system. Lancet 1982, i: 980–982.
Powers, W. J. Cerebrospinal fluid to serum glucose ratios in diabetes mellitus and bacterial meningitis. American Journal of Medicine 1981, 71: 217–220.
Donald, P. R., Malan, C., van der Walt, A. Simultaneous determination of cerebrospinal fluid glucose and blood glucose concentrations in the diagnosis of bacterial meningitis. Journal of Pediatrics 1983, 103: 413–415.
Onorato, I. M., Wormser, G. P., Nicholas, P. “Normal” CSF in bacterial meningitis. Journal of the American Medical Association 1980, 244: 1469–1471.
Fishbein, D. B., Palmer, D. L., Porter, K. M., Reed, W. P. Bacterial meningitis in the absence of CSF pleocytosis. Archives of Internal Medicine 1981, 141: 1369–1372.
Bohr, V., Rasmussen, N., Hansen, B., Kjersem, H., Jessen, O., Johnsen, N., Kristensen, H. S. 875 cases of bacterial meningitis: diagnostic procedures and the impact of preadmission antibiotic therapy. Part III of a three-part series. Journal of Infection 1983, 7: 193–202.
Hayward, R. A., Shapiro, M. F., Oye, R. K. Laboratory testing on cerebrospinal fluid. A reappraisal. Lancet 1987, i: 1–4.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lindquist, L., Linné, T., Hansson, L.O. et al. Value of cerebrospinal fluid analysis in the differential diagnosis of meningitis: A study in 710 patients with suspected central nervous system infection. Eur. J. Clin. Microbiol. Infect. Dis. 7, 374–380 (1988). https://doi.org/10.1007/BF01962340
Issue Date:
DOI: https://doi.org/10.1007/BF01962340