Estimation of cerebrospinal fluid lactate level to differentiate between pyogenic and non-pyogenic meningitis: a prospective analytical study


  • Gurrala Radhakrishna Department of Medicine, East Point Medical College and Research. Bangalore, Karnataka, India
  • Anil Kumar Department of Medicine, East Point Medical College and Research. Bangalore, Karnataka, India
  • Gurrala Kartheek Krishna Department of Medicine, ASRMS, Eluru, Andhra Pradesh, India



Meningitis, Pyogenic, CSF analysis, Lactate levels


Background: Meningitis is one of the common causes of serious morbidity and mortality and is one of the common causes of intensive care unit (ICU) admissions. The meningitis can be broadly divided into bacterial, viral or fungal meningitis. It is important to differentiate between pyogenic and non-pyogenic meningitis because of obvious management implications. Cerebrospinal fluid (CSF) lactate levels can be used for differentiating pyogenic and non-pyogenic (viral/tubercular) meningitis.

Methods: This was a prospective analytical study in which cases diagnosed to be having meningitis were included on the basis of a predefined inclusion and exclusion criteria. Demographic details such as age, gender and socioeconomic status was note in all the cases. A detailed clinical history was taken and a through clinical examination was done. Imaging (computerized tomography) was done in selected cases. CSF cytology, biochemistry and culture sensitivity were done in all cases. CSF lactate was determined in all cases.

Results: The CSF cytological examination showed that the mean total cell count was more (643.23±102.02) in pyogenic meningitis as compared to non-pyogenic (viral/tubercular) meningitis (121.76±59.74) and the difference was found to be statistically highly significant (p<0.0001). The analysis of CSF lactate levels showed that pyogenic meningitis cases had a significantly high level of CSF lactate as compared to non-pyogenic meningitis cases and the difference was found to be statistically highly significant (p<0.0001).

Conclusions: CSF lactate level is a good indicator in differentiating pyogenic and non-pyogenic meningitis.


Rohde S. Inflammatory Diseases of the Meninges. Inflammatory Diseases of the Brain. 2012;127-37.

Jarousha AM, Afifi AA. Epidemiology and Risk Factors Associated with Developing Bacterial Meningitis among Children in Gaza Strip. Iran J Public Health. 2014;43(9):1176-83.

El Bashir H, Laundy M, Booy R. Diagnosis and treatment of bacterial meningitis. Arch Dis Child. 2003;88(7):615-20.

Marx GE, Chan ED. Tuberculous meningitis: diagnosis and treatment overview. Tuberc Res Treat. 2011;798764.

Gottfredsson M, Perfect JR. Fungal meningitis. Semin Neurol. 2000;20(3):307-22.

Khalessi N, Afsharkhas L. Neonatal meningitis: risk factors, causes, and neurologic complications. Iran J Child Neurol. 2014;8(4):46-50.

Hrishi AP, Sethuraman M. Cerebrospinal Fluid (CSF) Analysis and Interpretation in Neurocritical Care for Acute Neurological Conditions. Indian J Crit Care Med. 2019;23(2):115-9.

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;14(6):240.

Bagheri-Nesami M, Babamahmoodi F, Nikkhah A. Types, Risk Factors, Clinical symptoms and Diagnostic Tests of Acute Adult Meningitis in Northern Iran During 2006-2012. J Clin Diagn Res. 2015;9(5):1-5.

Basri R, Zueter AR, Mohamed Z, Alam MK, Norsa'adah B, Hasan SA, et al. Burden of bacterial meningitis: a retrospective review on laboratory parameters and factors associated with death in meningitis, kelantan Malaysia. Nagoya J Med Sci. 2015;77(1-2):59-68.

Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev. 2010;23(3):467-92.

Gudina EK, Tesfaye M, Wieser A, Pfister HW, Klein M. Outcome of patients with acute bacterial meningitis in a teaching hospital in Ethiopia: A prospective study. PLoS One. 2018;13(7):e0200067.

Shukla B, Aguilera EA, Salazar L, Wootton SH, Kaewpoowat Q, Hasbun R. Aseptic meningitis in adults and children: Diagnostic and management challenges. J Clin Virol. 2017;94:110-4.

Ihekwaba UK, Kudesia G, McKendrick MW. Clinical features of viral meningitis in adults: significant differences in cerebrospinal fluid findings among herpes simplex virus, varicella zoster virus, and enterovirus infections. Clin Infect Dis. 2008;47(6):783-9.

Subrahmanyam CV, Vidavaluru M. Role of cerebro spinal fluid lactate as a diagnostic marker for differentiation from bacterial and aseptic meningitis. Int J Adv Med. 2020;7:887-92.

Kastenbauer S, HW Pfister. Pneumococcal meningitis in adults. Spectrum of complications and prognostic factors in a series of 87 cases. Brain. 2003;26(5):1015-25.

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

Abro AH, Abdou AS, Ali H, Ustadi AM, Hasab AAH. Cerebrospinal fluid analysis acute bacterial versus viral meningitis. Pak J Med Sci. 2008;24:645-50.

Genton B, Berger JP. Cerebrospinal fluid lactate in 78 cases of adult meningitis. Intensive Care Med. 1990;16:196-200.

Cameron PD, Boyce JM, Ansari BM. Cerebrospinal fluid lactate in meningitis and meningococcaemia. J Infect. 1993;26:245-52.






Original Research Articles