The Role of CSF LDH Estimation to Differentiate Different Types of Meningitis: A Cross Sectional Study | Chapter 9 | Highlights on Medicine and Medical Research Vol. 11

 Meningitis is a medical condition that causes the meninges to become inflamed.

Meningitis is a medical, neurologic, and sometimes neurosurgical emergency that requires a multidisciplinary approach to care. Meningitis is divided into two forms anatomically: pachymeningitis (inflammation of the dura), which is less common, and leptomeningitis (inflammation of the arachnoid and subarchanoid space), which is more common. Early and correct diagnosis is crucial to a positive outcome. The cerebrospinal fluid analysis is the most important part of the diagnostic process. Complete count, differential count, protein, sugar, gramme staining culture and sensitivity, AFB staining, and, in some cases, gramme staining. The cerebrospinal fluid analysis includes CSF ADA and Tuberculous RNA PCR. Other tests, such as CSF lactate, C-Reactive Protein, SGOT, glutamate level, and Lactate Dehydrogenase, may be done (LDH). Despite the fact that CSF anomalies in meningitis have been well reported, only a few studies have been performed in our area. The aim of this study is to determine the function of CSF LDH in differentiating between different types of meningitis.

Materials and Methods: A cross-sectional study was carried out in a hospital. All patients admitted to a tertiary care centre in South Kerala with confirmed clinical and biochemical evidence of meningitis (viral, bacterial, or tuberculous) were included between April 2012 and March 2013. After obtaining informed consent from patients and applying inclusion and exclusion requirements, those who met all of the inclusion criteria underwent a thorough examination, which included lumbar puncture (for CSF selection and analysis).

Based on the criterion, patients were divided into four groups: infectious, bacterial, tuberculous, and partly treated meningitis. The amount of LDH in the CSF was measured to see if it had anything to do with the diagnosis. The unpaired T test was used to compare the mean LDH levels in various types of meningitis. The correlation was confirmed using the Chi square test.

Observations: There were 180 patients in this sample, 111 of whom were men and 69 of whom were women. The majority of patients with bacterial and viral meningitis were younger, ranging in age from 31 to 40 years, while tuberculous meningitis patients were older, ranging in age from 61 to 70 years. According to the study descriptions, 33 percent of the 180 patients had bacterial meningitis, 33 percent had viral meningitis, 4.44 percent had tuberculous meningitis, and 28.88 percent had partly treated meningitis. Patients with bacterial meningitis had a white blood cell count of 613, tuberculous meningitis had a count of 656, and viral meningitis had a count of 101 cells per mm3. The differential count in the bacterial population was mostly polymorphs, whereas it was mostly lymphocytic in the other classes. The average CSF protein for bacterial meningitis was 102.4 mg/dl, 33.6 mg/dl for viral meningitis, 89.4 mg/dl for tuberculous meningitis, and 75.47 mg/dl for partly treated meningitis. Bacterial meningitis had a CSF sugar value of 29.5 mg/dl, viral meningitis had a value of 68.4 mg/dl, Tuberculous meningitis had a value of 23.3 mg/dl, and the partly treated population had a value of 43.03 mg/dl. In the bacterial meningitis group, the average ADA value was 6.4, 4.8 in the viral meningitis group, and 20 in the tuberculous meningitis group. The tuberculous group had the highest average ADA value, which we found. The ADA of 17 of the 18 tuberculosis patients was greater than 15. In the bacterial meningitis group, the average CSF LDH value was 94.1 IU/L, 30.2 IU/L in the viral meningitis group, and 119.9 IU/L in the tuberculous meningitis group. positive attitude Other studies have not found such a high prevalence of encephalitis, indicating that JE is prevalent in our area. CSF LDH was substantially elevated in those who tested positive for JE. In the partially treated meningitis section, we had 52 patients (28.88%). 34 of them had signs of bacterial meningitis, while 6 had signs of tuberculous meningitis. In these two categories, the LDH level in the CSF was substantially higher. The remaining 12 patients with symptoms of viral meningitis had only a moderate elevation of LDH. In the viral meningitis and tuberculous meningitis classes, the mean CSF LDH was 77.2 and 22.5 percent, respectively.

Conclusion: CSF LDH levels were substantially elevated in both tuberculous and bacterial meningitis. CSF LDH was just slightly elevated in viral meningitis. JE was found in viral meningitis with elevated CSF LDH. As a result, high LDH in viral meningitis can increase suspicion of encephalitis.

Author (s) Details

S. P. Anita
Government Medical College, Manjeri, India.

R. Legha
Department of Medicine, Travancore Medical College, Kollam, India.

P. S. Manu
Department of Health Services, Government of Kerala, India.

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