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Open Access Highly Accessed Research

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

Alain Viallon1*, Nicolas Desseigne1, Olivier Marjollet1, Albert Birynczyk1, Mathieu Belin1, Stephane Guyomarch1, Jacques Borg2, Bruno Pozetto3, Jean Claude Bertrand1 and Fabrice Zeni1

Author Affiliations

1 Emergency and Intensive Care Units, North Hospital, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, 42055, Cedex 2, France

2 Biochemical Laboratory, North Hospital, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, 42055, Cedex 2, France

3 Microbiology Laboratory, North Hospital, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, 42055, Cedex 2, France

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Critical Care 2011, 15:R136  doi:10.1186/cc10254


See related letter by Zhang et al., http://ccforum.com/content/15/5/439

Published: 6 June 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.