a study comparing cerebrospinal fluid lactate levels in childhood culture positive and culture negative meningitis

despite recent innovations in the laboratory diagnosis of bacterial from nonbacterial meningitis, solid data-necessary for early determination of bacterial meningitis (bm) before organism growth in the culture medium-are missing. therefore cerebrospinal fluid (csf) lactate levels were evaluated as a possible means of differentiating the two clinical entities. this was a retrospective study. patients were studied in one year. they were divided into three groups: group one included 10 patients with culture positive meningitis group two included 10 patients with culture negative meningitis compatible with a viral etiology group three consisted of 10 febrile children without any biochemical or cytological csf abnormality as the normal controls. csf lactate level determinations were made enzymatically with boehringer mannheim reagents in addition to the formal biochemical and cytological investigations, consisting of cell counts and differential plus glucose and protein levels and csf/blood glucose ratio in all three groups. group one had a mean csf lactate level of 12.90 (±3.08) mmol/l, while in groups 2 and 3 the level was 1.89 (± 0.52) mmol/l and 1.63 (±0.31) mmol/l respectively. lactate levels were significantly higher in patients from group one with respect to the control group (p= 0.001) whereas there were no significant differences between group 2 and the control group. regarding temporal profile of csf markers and considering the rapid rise in csf lactate levels in bacterial meningitis, its measurement seems appealing to confirm a bacterial etiology instead of awaiting the results of csf culture.