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1.
Ziai WC, Lewin JJ III, 2006. Advances in the management of central nervous system infections in the ICU. Crit Care Clin 22: 661–694.
-
2.
van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M, 2004. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 351: 1849–1859.
-
3.
Petti CA, Polage CR, Quinn TC, Ronald AR, Sande MA, 2006. Laboratory medicine in Africa: a barrier to effective health care. Clin Infect Dis 42: 377–382.
-
4.
Ross D, Rosegay H, Pons V, 1988. Differentiation of aseptic and bacterial meningitis in postoperative neurosurgical patients. J Neurosurg 69: 669–674.
-
5.
Guerra-Romero L, Tauber MG, Fournier MA, Tureen JH, 1992. Lactate and glucose concentrations in brain interstitial fluid, cerebrospinal fluid, and serum during experimental pneumococcal meningitis. J Infect Dis 166: 546–550.
-
6.
Leib SL, Boscacci R, Gratzl O, Zimmerli W, 1999. Predictive value of cerebrospinal fluid (CSF) lactate level versus CSF/blood glucose ratio for the diagnosis of bacterial meningitis following neurosurgery. Clin Infect Dis 29: 69–74.
-
7.
Huy NT, Thao NT, Diep DT, Kikuchi M, Zamora J, Hirayama K, 2010. Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis. Crit Care 14: R240.
-
8.
Muhumuza J, Asiimwe BB, Kayes S, Mugyenyi R, Whalen C, Mugerwa RD, Boom H, Eisenach KD, Joloba ML, 2006. Introduction of an in-house PCR for routine identification of M. tuberculosis in a low-income country. Int J Tuberc Lung Dis 10: 1262–1267.
-
9.
Scarborough M, Thwaites GE, 2008. The diagnosis and management of acute bacterial meningitis in resource-poor settings. Lancet Neurol 7: 637–648.
-
10.
Bailey EM, Domenico P, Cunha BA, 1990. Bacterial or viral meningitis? Measuring lactate in CSF can help you know quickly. Postgrad Med 88: 217–219, 223.
-
11.
Cameron PD, Boyce JM, Ansari BM, 1993. Cerebrospinal fluid lactate in meningitis and meningococcaemia. J Infect 26: 245–252.
-
12.
Genton B, Berger JP, 1990. Cerebrospinal fluid lactate in 78 cases of adult meningitis. Intensive Care Med 16: 196–200.
-
13.
Trachtenberg JD, Kambugu AD, McKellar M, Semitala F, Mayanja-Kizza H, Samore MH, Ronald A, Sande MA, 2007. The medical management of central nervous system infections in Uganda and the potential impact of an algorithm-based approach to improve outcomes. Int J Infect Dis 11: 524–530.
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Handheld Point-of-Care Cerebrospinal Fluid Lactate Testing Predicts Bacterial Meningitis in Uganda
Albert Majwala
Albert Majwala
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
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Rebecca Burke
Rebecca Burke
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
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William Patterson
William Patterson
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
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Relana Pinkerton
Relana Pinkerton
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
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Conrad Muzoora
Conrad Muzoora
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
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L. Anthony Wilson
L. Anthony Wilson
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
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Christopher C. Moore
Christopher C. Moore
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
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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
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.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Ziai WC, Lewin JJ III, 2006. Advances in the management of central nervous system infections in the ICU. Crit Care Clin 22: 661–694.
-
2.
van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M, 2004. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 351: 1849–1859.
-
3.
Petti CA, Polage CR, Quinn TC, Ronald AR, Sande MA, 2006. Laboratory medicine in Africa: a barrier to effective health care. Clin Infect Dis 42: 377–382.
-
4.
Ross D, Rosegay H, Pons V, 1988. Differentiation of aseptic and bacterial meningitis in postoperative neurosurgical patients. J Neurosurg 69: 669–674.
-
5.
Guerra-Romero L, Tauber MG, Fournier MA, Tureen JH, 1992. Lactate and glucose concentrations in brain interstitial fluid, cerebrospinal fluid, and serum during experimental pneumococcal meningitis. J Infect Dis 166: 546–550.
-
6.
Leib SL, Boscacci R, Gratzl O, Zimmerli W, 1999. Predictive value of cerebrospinal fluid (CSF) lactate level versus CSF/blood glucose ratio for the diagnosis of bacterial meningitis following neurosurgery. Clin Infect Dis 29: 69–74.
-
7.
Huy NT, Thao NT, Diep DT, Kikuchi M, Zamora J, Hirayama K, 2010. Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis. Crit Care 14: R240.
-
8.
Muhumuza J, Asiimwe BB, Kayes S, Mugyenyi R, Whalen C, Mugerwa RD, Boom H, Eisenach KD, Joloba ML, 2006. Introduction of an in-house PCR for routine identification of M. tuberculosis in a low-income country. Int J Tuberc Lung Dis 10: 1262–1267.
-
9.
Scarborough M, Thwaites GE, 2008. The diagnosis and management of acute bacterial meningitis in resource-poor settings. Lancet Neurol 7: 637–648.
-
10.
Bailey EM, Domenico P, Cunha BA, 1990. Bacterial or viral meningitis? Measuring lactate in CSF can help you know quickly. Postgrad Med 88: 217–219, 223.
-
11.
Cameron PD, Boyce JM, Ansari BM, 1993. Cerebrospinal fluid lactate in meningitis and meningococcaemia. J Infect 26: 245–252.
-
12.
Genton B, Berger JP, 1990. Cerebrospinal fluid lactate in 78 cases of adult meningitis. Intensive Care Med 16: 196–200.
-
13.
Trachtenberg JD, Kambugu AD, McKellar M, Semitala F, Mayanja-Kizza H, Samore MH, Ronald A, Sande MA, 2007. The medical management of central nervous system infections in Uganda and the potential impact of an algorithm-based approach to improve outcomes. Int J Infect Dis 11: 524–530.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 54 | 54 | 3 |
| Full Text Views | 275 | 71 | 0 |
| PDF Downloads | 61 | 10 | 0 |