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Handheld Point-of-Care Cerebrospinal Fluid Lactate Testing Predicts Bacterial Meningitis in Uganda

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  • Department of Internal Medicine, Mbarara Regional Referral Hospital, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Department of Laboratory Medicine, University of Virginia School of Medicine, Charlottesville, Virginia; Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia

We validated a handheld point-of-care lactate (POCL) monitor's ability to measure lactate in cerebrospinal fluid (CSF) and diagnose bacterial meningitis in Uganda. There was a strong linear correspondence between POCL and standard laboratory lactate test results (R2 = 0.86; P < 0.001). For 145 patients with clinical meningitis, the area under the receiver operating characteristic curve for the prediction of bacterial meningitis by CSF POCL was 0.92 (95% confidence interval = 0.85–0.99, P < 0.001). A CSF POCL concentration of 7.7 mmol/L provided 88% sensitivity and 90% specificity for the diagnosis of bacterial meningitis. CSF POCL testing had excellent use in the diagnosis of bacterial meningitis, and it may be useful where CSF analyses are delayed or laboratory infrastructure is limited.

Author Notes

* Address correspondence to Christopher C. Moore, Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, 409 Lane Road, 2154 MR-4 Building, Charlottesville, VA 22908. E-mail: ccm5u@virginia.edu

Financial support: A.M., R.B., and C.C.M. received fellowships from the Pfizer Initiative in International Health at the University of Virginia to support this work. The Pfizer Initiative in International Health at the University of Virginia was conceived to fund exchange programs of post-doctoral fellows and students between the University of Virginia and several international partners to conduct research on global health issues. The major purpose of this program is to foster and enhance bidirectional research training for treating infectious diseases like acquired immunodeficiency syndrome, tuberculosis, and malaria. Pfizer provided funds to promote the Initiative but has no role in the planning or execution of research protocols, including the study described in our manuscript. An independent board at the University of Virginia determines the research proposals that are funded.

Authors' addresses: Albert Majwala, Conrad Muzoora, and L. Anthony Wilson, Mbarara Regional Referral Hospital, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda, E-mails: majalb2k@yahoo.com, conradmuzoora@yahoo.com, and tonywislon@gmail.com. Rebecca Burke, Department of Medicine, Duke University School of Medicine, Durham, NC, E-mail: rebeccaburke00@gmail.com. William Patterson, Department of Laboratory Medicine, University of Virginia School of Medicine, Charlottesville, VA, E-mail: wmp4c@virginia.edu. Relana Pinkerton and Christopher C. Moore, Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, E-mails: rcp3w@virginia.edu and ccm5u@virginia.edu.

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