Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1981 Sep;56(9):692–698. doi: 10.1136/adc.56.9.692

Cerebrospinal fluid lactic acidosis in bacterial meningitis.

J Eross, M Silink, D Dorman
PMCID: PMC1627295  PMID: 7294872

Abstract

A rapid, microenzymatic method was used to measure cerebrospinal fluid lactate levels in 205 children with suspected bacterial meningitis. Fifty children with normal CSF containing fewer than 0.005 X 10(9)/l WBC, no segmented neutrophils, glucose 3.4 +/- 0.8 mmol/l (61.2 +/- 14.4 mg/100 ml), and a protein of less than 0.30 g/l had CSF lactate levels below 2.0 mmol/l (18 mg/100 ml) (mean and standard deviation 1.3 +/- 0.3 mmol/l (11.8 +/- 2.7 mg/100 ml)). In 31 cases of proved viral meningitis as with 58 cases of clinically diagnosed viral meningitis, levels were below 3.8 mmol/l (34.5 mg/100 ml), being 2.3 +/- 0.6 mmol/l (20.9 +/- 5.4 mg/100 ml), and 2.1 +/- 0.7 mmol/l (19.1 +/- 6.4 mg/100 ml) respectively. Sixty-six cases of bacterial meningitis had CSF lactate levels ranging from 3.9 mmol/l (35.4 mg/100 ml) to greater than 10.0 mmol/l (90.0 mg/100 ml). Longitudinal studies in 7 children with bacterial meningitis showed that cerebrospinal fluid lactate levels differentiated bacterial from viral meningitis up to 4 days after starting treatment with antibiotics. Use of CSF lactate measurement for monitoring the efficacy of treatment is illustrated in a case of bacterial meningitis due to Pseudomonas aeruginosa. The origin of the cerebrospinal fluid lactate acidosis and the role of lactate in the pathophysiological cycle leading to intensification of brain tissue hypoxia and cellular damage is discussed with respect to the short-term prognosis and the long-term neurological sequelae.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bland R. D., Lister R. C., Ries J. P. Cerebrospinal fluid lactic acid level and pH in meningitis. Aids in differential diagnosis. Am J Dis Child. 1974 Aug;128(2):151–156. doi: 10.1001/archpedi.1974.02110270025006. [DOI] [PubMed] [Google Scholar]
  2. Brook I., Bricknell K. S., Overturf G. D., Finegold S. M. Measurement of lactic acid in cerebrospinal fluid of patients with infections of the central nervous system. J Infect Dis. 1978 Apr;137(4):384–390. doi: 10.1093/infdis/137.4.384. [DOI] [PubMed] [Google Scholar]
  3. COHN Z. A., MORSE S. I. Functional and metabolic properties of polymorphonuclear leucocytes. II. The influence of a lipopolysaccharide endotoxin. J Exp Med. 1960 May 1;111:689–704. doi: 10.1084/jem.111.5.689. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cold G., Enevoldsen E., Malmros R. Ventricular fluid lactate, pyruvate, bicarbonate and ph in unconscious brain-injured patients subjected to controlled ventilation. Acta Neurol Scand. 1975 Sep;52(3):187–195. doi: 10.1111/j.1600-0404.1975.tb05773.x. [DOI] [PubMed] [Google Scholar]
  5. Controni G., Rodriguez W. J., Hicks J. M., Ficke M., Ross S., Friedman G., Khan W. Cerebrospinal fluid lactic acid levels in meningitis. J Pediatr. 1977 Sep;91(3):379–384. doi: 10.1016/s0022-3476(77)81304-8. [DOI] [PubMed] [Google Scholar]
  6. Converse G. M., Gwaltney J. M., Jr, Strassburg D. A., Hendley J. O. Alteration of cerebrospinal fluid findings by partial treatment of bacterial meningitis. J Pediatr. 1973 Aug;83(2):220–225. doi: 10.1016/s0022-3476(73)80479-2. [DOI] [PubMed] [Google Scholar]
  7. Coonrod J. D., Rytel M. W. Determination of aetiology of bacterial meningitis by counter-immunoelectrophoresis. Lancet. 1972 May 27;1(7761):1154–1157. doi: 10.1016/s0140-6736(72)91376-1. [DOI] [PubMed] [Google Scholar]
  8. Crockard H. A., Taylor A. R. Serial CSF lactate-pyruvate values as a guide to prognosis in head injury coma. Eur Neurol. 1972;8(1):151–157. doi: 10.1159/000114569. [DOI] [PubMed] [Google Scholar]
  9. Czernicki Z., Grochowski W. Mleczany w płynie mózgowo-rdzeniowym po urazach czaszkowo-mózgowych. Neurol Neurochir Pol. 1976 Sep-Oct;10(5):651–653. [PubMed] [Google Scholar]
  10. D'Souza E., Mandal B. K., Hooper J., Parker L. Lactic-acid concentration in cerebrospinal fluid and differential diagnosis of meningitis. Lancet. 1978 Sep 9;2(8089):579–580. doi: 10.1016/s0140-6736(78)92918-5. [DOI] [PubMed] [Google Scholar]
  11. Dalton H. P., Allison M. J. Modification of laboratory results by partial treatment of bacterial meningitis. Am J Clin Pathol. 1968 Mar;49(3):410–413. doi: 10.1093/ajcp/49.3.410. [DOI] [PubMed] [Google Scholar]
  12. Feigin R. D., Shackelford P. G. Value of repeat lumbar puncture in the differential diagnosis of meningitis. N Engl J Med. 1973 Sep 13;289(11):571–574. doi: 10.1056/NEJM197309132891108. [DOI] [PubMed] [Google Scholar]
  13. Ferguson I. R., Tearle P. V. Gas liquid chromatography in the rapid diagnosis of meningitis. J Clin Pathol. 1977 Dec;30(12):1163–1167. doi: 10.1136/jcp.30.12.1163. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Fierro H., Chacón A., Gutierrez G., Muñoz O. Valores de pH y ácido láctico en el líquido cefalorraquídeo como ayuda diagnóstica para diferenciar meningoencefalitis viral y purulenta. Arch Invest Med (Mex) 1977;8(3):185–197. [PubMed] [Google Scholar]
  15. Fikrig S. M., Berkovich S., Emmett S. M., Gordon C. Nitroblue tetrazolium dye test and differential diagnosis of meningitis. J Pediatr. 1973 May;82(5):855–857. doi: 10.1016/s0022-3476(73)80082-4. [DOI] [PubMed] [Google Scholar]
  16. Gandhi P. C., Khan M. A., Mathur P. S., Singh V. Lactic acid levels in cerebro-spinal fluid in various meningitides in infancy and childhood. Indian Pediatr. 1977 Jul;14(7):505–510. [PubMed] [Google Scholar]
  17. HARTER D. H. PRELIMINARY ANTIBIOTIC THERAPY IN BACTERIAL MENINGITIS. Arch Neurol. 1963 Oct;9:343–347. doi: 10.1001/archneur.1963.00460100031002. [DOI] [PubMed] [Google Scholar]
  18. Hansen E. L., Kristensen H. S., Brodersen P., Paulson O. B., Müllertz S., Jessen O. Acid-base pattern of cerebrospinal fluid and arterial blood in bacterial meningitis and in encephalitis. Acta Med Scand. 1974 Nov;196(5):431–437. doi: 10.1111/j.0954-6820.1974.tb01035.x. [DOI] [PubMed] [Google Scholar]
  19. Hurd C. A., Fennema K. J., Blazevic D. J. Use of cerebrospinal fluid lactate levels in the diagnosis of bacterial meningitis. Am J Med Technol. 1978 Jan;44(1):11–13. [PubMed] [Google Scholar]
  20. Hyslop N. E., Jr, Swartz M. N. Bacterial meningitis. Postgrad Med. 1975 Sep;58(3):120–128. doi: 10.1080/00325481.1975.11714145. [DOI] [PubMed] [Google Scholar]
  21. Jarvis C. W., Saxena K. M. Does prior antibiotic treatment hamper the diagnosis of acute bacterial meningitis? An analysis of a series of 135 childhood cases. Clin Pediatr (Phila) 1972 Apr;11(4):201–204. doi: 10.1177/000992287201100406. [DOI] [PubMed] [Google Scholar]
  22. Komorowski R. A., Farmer S. G., Hanson G. A., Hause L. L. Cerebrospinal fluid lactic acid in diagnosis of meningitis. J Clin Microbiol. 1978 Jul;8(1):89–92. doi: 10.1128/jcm.8.1.89-92.1978. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Lamisse F., Grenier B., Choutet P., Rolland J. C., Gautier J. Intérêt du dosage de l'acide lactique dans le liquide rachidien pour le diagnostic des meningites purulentes. Lyon Med. 1972 Nov 26;228(18):591–595. [PubMed] [Google Scholar]
  24. Langfitt T. W. Increased intracranial pressure. Clin Neurosurg. 1969;16:436–471. doi: 10.1093/neurosurgery/16.cn_suppl_1.436. [DOI] [PubMed] [Google Scholar]
  25. Lauwers S. Apport du dosage d'acide lactique dans le L.C.R. au diagnostic différentiel des méningites. Acta Clin Belg. 1977;32(5):319–325. doi: 10.1080/17843286.1977.11717881. [DOI] [PubMed] [Google Scholar]
  26. MONTANI S., PERRET C. ACIDOSE LACTIQUE DU LIQUIDE C'EPHALO-RACHIDIEN DANS LES M'ENINGITES BACT'ERIENNES. Schweiz Med Wochenschr. 1964 Oct 31;94:1552–1557. [PubMed] [Google Scholar]
  27. Menkes J. H. The causes for low spinal fluid sugar in bacterial meningitis: another look. Pediatrics. 1969 Jul;44(1):1–3. [PubMed] [Google Scholar]
  28. NYHAN W. L., RICHARDSON F. Complications of meningitis. Annu Rev Med. 1963;14:243–260. doi: 10.1146/annurev.me.14.020163.001331. [DOI] [PubMed] [Google Scholar]
  29. Nachum R., Lipsey A., Siegel S. E. Rapid detection of gram-negative bacterial meningitis by the limulus lysate test. N Engl J Med. 1973 Nov 1;289(18):931–934. doi: 10.1056/NEJM197311012891801. [DOI] [PubMed] [Google Scholar]
  30. Neches W., Platt M. Cerebrospinal fluid LDH in 287 children, including 53 cases of meningitis of bacterial and non-bacterial etiology. Pediatrics. 1968 Jun;41(6):1097–1103. [PubMed] [Google Scholar]
  31. Paulson O. B., Brodersen P., Hansen E. L., Kristensen H. S. Regional cerebral blood flow, cerebral metabolic rate of oxygen, and cerebrospinal fluid acid-base variables in patients with acute meningitis and with acute encephalitis. Acta Med Scand. 1974 Sep;196(3):191–198. doi: 10.1111/j.0954-6820.1974.tb00994.x. [DOI] [PubMed] [Google Scholar]
  32. Prockop L. D. Cerebrospinal fluid lactic acid. Clearance and effect on facilitated diffusion of a glucose analogue. Neurology. 1968 Feb;18(2):189–196. doi: 10.1212/wnl.18.2.189. [DOI] [PubMed] [Google Scholar]
  33. QUAADE F., KRISTENSEN K. P. Purulent meningitis. A review of 658 cases. Acta Med Scand. 1962 May;171:543–550. [PubMed] [Google Scholar]
  34. Raisis J. E., Kindt G. W., McGillicuddy J. E., Miller C. A. Cerebrospinal fluid lactate and lactate/pyruvate ratios in hydrocephalus. J Neurosurg. 1976 Mar;44(3):337–341. doi: 10.3171/jns.1976.44.3.0337. [DOI] [PubMed] [Google Scholar]
  35. Raudam E. I., Rivis E. K. Prognosticheskoe znachenie soderzhaniia laktata i otnosheniia laktat/piruvat v spinomozgovoi zhidkosti pri ostrykh narusheniiakh mozgovogo krovoobrashcheniia. Vopr Neirokhir. 1976 Mar-Apr;(2):32–37. [PubMed] [Google Scholar]
  36. Seitz H. D., Ocker K. The prognostic and therapeutic importance of changes in the CSF during the acute stage of brain injury. Acta Neurochir (Wien) 1977;38(3-4):211–231. doi: 10.1007/BF01401092. [DOI] [PubMed] [Google Scholar]
  37. Sell S. H., Merrill R. E., Doyne E. O., Zimsky E. P., Jr Long-term sequelae of Hemophilus influenzae meningitis. Pediatrics. 1972 Feb;49(2):206–211. [PubMed] [Google Scholar]
  38. Simpson H., Habel A. H., George E. L. Cerebrospinal fluid acid-base status and lactate and pyruvate concentrations after convulsions of varied duration and aetiology in children. Arch Dis Child. 1977 Nov;52(11):844–849. doi: 10.1136/adc.52.11.844. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Valenca L. M., Shannon D. C., Kazemi H. Clearance of lactate from the cerebrospinal fluid. Neurology. 1971 Jun;21(6):615–620. doi: 10.1212/wnl.21.6.615. [DOI] [PubMed] [Google Scholar]
  40. Yalaz K. Cerebro-spinal fluid lactate concentration in neurologically normal and abnormal children. Turk J Pediatr. 1970 Jan-Apr;12(1):8–15. [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES