Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011;15(3):R136.
doi: 10.1186/cc10254. Epub 2011 Jun 6.

Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis

Alain Viallon  1 , Nicolas Desseigne, Olivier Marjollet, Albert Birynczyk, Mathieu Belin, Stephane Guyomarch, Jacques Borg, Bruno Pozetto, Jean Claude Bertrand, Fabrice Zeni
Affiliations

Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis

Alain Viallon et al. Crit Care. 2011.

Abstract

Introduction: The objective of this study was to determine the ability of various parameters commonly used for the diagnosis of acute meningitis to differentiate between bacterial and viral meningitis, in adult patients with a negative direct cerebrospinal fluid (CSF) examination.

Methods: This was a prospective study, started in 1997, including all patients admitted to the emergency unit with acute meningitis and a negative direct CSF examination. Serum and CSF samples were taken immediately on admission. The patients were divided into two groups according to the type of meningitis: bacterial (BM; group I) or viral (VM; group II). The CSF parameters investigated were cytology, protein, glucose, and lactate; the serum parameters evaluated were C-reactive protein and procalcitonin. CSF/serum glucose and lactate ratios were also assessed.

Results: Of the 254 patients with meningitis with a negative direct CSF examination, 35 had BM and 181, VM. The most highly discriminative parameters for the differential diagnosis of BM proved to be CSF lactate, with a sensitivity of 94%, a specificity of 92%, a negative predictive value of 99%, a positive predictive value of 82% at a diagnostic cut-off level of 3.8 mmol/L (area under the curve (AUC), 0.96; 95% confidence interval (CI), 0.95 to 1), and serum procalcitonin, with a sensitivity of 95%, a specificity of 100%, a negative predictive value of 100%, and a positive predictive value of 97% at a diagnostic cut-off level of 0.28 ng/ml (AUC, 0.99; 95% CI, 0.99 to 1).

Conclusions: Serum procalcitonin and CSF lactate concentrations appear to be the most highly discriminative parameters for the differential diagnosis of BM and VM.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Receiver operating characteristic (ROC) curves of the two most highly discriminative parameters (CSF, cerebrospinal fluid; Se, serum).
Figure 2
Figure 2
Receiver operating characteristic (ROC) curves of the other parameters studied (CSF, cerebrospinal fluid; Se, serum).
See this image and copyright information in PMC

Comment in

References

    1. Tunkel AR, Hartman BJ, Sheldon SL, Kaufman BA, Ross KL, Scheld WM, Whitley RJ. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39:1267–1284. doi: 10.1086/425368. - DOI - PubMed
    1. Aronin SI, Peduzzi P, Quagliarello VJ. Community-acquired bacterial meningitis: risk stratification for adverse outcome and effect of antibiotic timing. Ann Intern Med. 1998;129:862–869. - PubMed
    1. Lu CH, Huang CR, Chang WN, Chang CJ, Cheng BC, Lee PY, Lin MW, Chang HW. Community-acquired bacterial meningitis in adults: the epidemiology, timing of appropriate antimicrobial therapy, and prognostic factors. Clin Neurol Neurosurg. 2002;104:352–358. doi: 10.1016/S0303-8467(02)00052-5. - DOI - PubMed
    1. Miner JR, Heegarrd W, Mapes A, Biros M. Presentation, time to antibiotics, and mortality of patients with bacterial meningitis at an urban medical center. J Emerg Med. 2001;21:387–392. doi: 10.1016/S0736-4679(01)00407-3. - DOI - PubMed
    1. Proulx N, Frechette D, Toye B, Chan J, Kraveik S. Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. QJM. 2005;98:291–298. doi: 10.1093/qjmed/hci047. - DOI - PubMed

MeSH terms