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Quantification of cerebrospinal fluid lactic acid in the differential diagnosis between HIV chronic meningitis and opportunistic meningitis
-
Sérgio Monteiro de Almeida
,
Kátia Boritza
Published/Copyright:
February 11, 2011
Abstract
Background: Approximately 40% of HIV infected patients have chronic meningitis at various stages during the infection, 59% are asymptomatic. This is a diagnosis of exclusion and a confounding factor in cerebrospinal fluid (CSF) analysis, any other causes of chronic meningitis by opportunistic or co-infection must be ruled out. The aim of this study was to analyze CSF lactic acid (LA) as an adjuvant biomarker in chronic meningitis due to HIV.
Methods: CSF LA was quantified in 223 CSF samples by the Dimension AR (Dade Behring, Deerfield, IL, USA), distributed into nine groups: 1) HIV positive with an increase in CSF WBCs (n=17); 2) HIV positive with normal CSF (n=20); 3) enterovirus meningitis (n=33); 4) Herpesviridae meningoencephalitis (n=30); 5) fungal meningitis (n=25); 6) tuberculosis (TB) meningitis (n=17); 7) toxoplasmosis (n=18); 8) neurosyphilis (n=6); 9) control group (n=57).
Results: CSF LA (median; IQR) was higher in samples with TB meningitis (5.5; 2.9–7.5 mmol/L) and Cryptococcus neoformans meningitis (3.9; 2.7–5.8 mmol/L) compated with samples with HIV chronic meningitis (1.7; 1.4–1.9 mmol/L) and other groups (p≤0.0001). For the diagnosis of HIV chronic meningitis, using a cut-off of 3.5 mmol/L, CSF LA showed high sensitivity and negative predictive value, although low specificity.
Conclusions: CSF LA helps to discriminate between C. neoformans or TB meningitis and HIV chronic meningitis: CSF LA can be included with the methods currently used to identify these specific pathogens, though it does not replace them. It is rapid, inexpensive and easy to perform, and can be used in developing countries.
Keywords: Cryptococcus neoformans; central nervous system; cerebrospinal fluid; chronic meningitis; HIV; lactic acid; lymphocytic meningitis; tuberculosis; viral meningitis
Received: 2010-8-6
Accepted: 2010-11-25
Published Online: 2011-02-11
Published in Print: 2011-05-01
©2011 by Walter de Gruyter Berlin New York
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Keywords for this article
Cryptococcus neoformans;
central nervous system;
cerebrospinal fluid;
chronic meningitis;
HIV;
lactic acid;
lymphocytic meningitis;
tuberculosis;
viral meningitis
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- Circulating macrocomplexes: old wine in new bottles?
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- Collective opinion paper on findings of the 2010 convocation of experts on laboratory quality
- Genetics and Molecular Diagnostics
- Genetic variability of the fructosamine 3-kinase gene in diabetic patients
- Identification of Bcl-2/IgH fusion sequences using real-time PCR and chip-based microcapillary electrophoresis
- Performance evaluation of a multiplex assay for future use in biomarker discovery efforts to predict body composition
- Pharmacogenetics of tacrolimus after renal transplantation: analysis of polymorphisms in genes encoding 16 drug metabolizing enzymes
- General Clinical Chemistry and Laboratory Medicine
- Quality Indicators in Laboratory Medicine: from theory to practice
- Implementation of computerized add-on testing for hospitalized patients in a large academic medical center
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