Role of cerebro spinal fluid lactate as a diagnostic marker for differentiation from bacterial and aseptic meningitis


  • Chintha Venkata Subrahmanyam Department of General Medicine, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
  • Mahesh Vidavaluru Department of General Medicine, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India



CSF analysis, CSF lactate, CSF protein, Meningitis


Background: Meningitis is serious and a life threatening condition among any age group associated with serious mortality and morbidity. CSF lactate may be a good marker to differentiate bacterial from other cause of meningitis. Objective of this study is to evaluate the efficiency of CSF lactate in differentiating bacterial/ pyogenic from non pyogenic meningitis.

Methods: A one year prospective study with all cases diagnosed as meningitis was enrolled and CSF analysis was done. Patients were grouped as bacteria, viral and tubercular meningitis based on clinical and CSF analysis. All cytological, biochemical and CSF lactate were estimated and compared with lactate to differentiate pyogenic from non pyogenic meningitis. Statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 20.

Results: A total of 120 cases with 74 males and 46 females, majority in 31-50 years age group were included. 59 pyogenic, 37 tubercular and 24 viral meningitis cases were diagnosed. Fever was common symptom (91.67%). Mean CSF protein was highest in pyogenic meningitis (271.1±142.28), 26 cases of tubercular meningitis demonstrated elevated levels of CSF lactate with a cut-off value of >2.1mmol/l (70.27%), five cases of viral meningitis (13.51%) and all 59 cases of pyogenic meningitis (100%).

Conclusions: This present study concludes that CSF lactate could be a reliable and valid marker in early differentiation of pyogenic from cases of nonpyogenic meningitis. Early detection may help in early decision on the type and institution of appropriate management could reduce the mortality and morbidity of meningitis.


Tavares WM, Machado AG, Matushita H, Plese JP. CSF markers for diagnosis of bacterial meningitis in neurosurgical postoperative patients. Arquiv Neur Psiquiat. 2006 Sep;64(3A):592-5.

Kleine TO, Zwerenz P, Zöfel P, Shiratori K. New and old diagnostic markers of meningitis in cerebrospinal fluid (CSF). Brain Res Bull. 2003 Aug 15;61(3):287-97.

Scarborough M, Thwaites GE. The diagnosis and management of acute bacterial meningitis in resource-poor settings. Lancet Neurol. 2008 Jul 1;7(7):637-48.

Holbrook I, Beetham R, Cruickshank A, Egner W, Fahie-Wilson M, Keir G, et al. National audit of cerebrospinal fluid testing. Ann Clini Biochem. 2007 Sep 1;44(5):443-8.

Van de Beek D, De Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. New Engl J Medi. 2004 Oct 28;351(18):1849-59.

Heyderman RS, Lambert HP, O'Sullivan I, Stuart JM, Taylor BL, Wall RA. Early management of suspected bacterial meningitis and meningococcal septicaemia in adults. J Infect. 2003 Feb 1;46(2):75-7.

Asuti S, Jagadish G, Narayan A. Estimation of CSF lactate as a diagnostic marker to differentiate pyogenic meningitis from nonpyogenic meningitis. Indian J Neurosci. 2019;5(3):106-12.

Chavanet P, Schaller C, Levy C, Flores-Cordero J, Arens M, Piroth L, et al. Performance of a predictive rule to distinguish bacterial and viral meningitis. J Infect. 2007 Apr 1;54(4):328-36.

Kumar Singh R, Usmani F, Haque SS, Tanweeruddin M, Singh BK. Estimation of Lactate Dehydrogenase Activity in cerebrospinal fluid in different types of meningitis. Int J Adv Biolog Biomed Res. 2017;5(1):48-51.

Negrini B, Kelleher KJ, Wald ER. Cerebrospinal fluid findings in aseptic versus bacterial meningitis. Pediatrics. 2000 Feb 1;105(2):316-9.

Huy NT, Thao NT, Diep DT, Kikuchi M, Zamora J, Hirayama K. Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis. Crit Care. 2010 Dec 1;14(6):R240.

Viallon A, Desseigne N, Marjollet O, Birynczyk A, Belin M, Guyomarch S, et al. Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis. Crit Care. 2011 Jun 1;15(3):R136.

Ray P, Badarou-Acossi G, Viallon A, Boutoille D, Arthaud M, Trystram D, et al. Accuracy of the cerebrospinal fluid results to differentiate bacterial from non-bacterial meningitis, in case of negative gram-stained smear. Am J Emerg Medi. 2007 Feb 1;25(2):179-84.

Mandal BK, Dunbar EM, Hooper J, Parker L. How useful is cerebrospinal fluid lactate estimation in differential diagnosis of meningitis?. J Infect. 1983 May 1;6(3):231-7.

Leen WG, Willemsen MA, Wevers RA, Verbeek MM. Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. PloS One. 2012;7(8).






Original Research Articles