Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis.
Nguyen Tien Huy,Nguyen Th Thao,Doan Tn Diep,Doan Tn Diep,Mihoko Kikuchi,Javier Zamora,Kenji Hirayama +6 more
TL;DR: To distinguish bacterialMeningitis from aseptic meningitis, CSF lactate is a good single indicator and a better marker compared to other conventional markers.
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Abstract: Making a differential diagnosis between bacterial meningitis and aseptic meningitis is a critical clinical problem. The utility of a cerebrospinal fluid (CSF) lactate assay for this purpose has been debated and is not yet routinely clinically performed. To adequately evaluate this assay, a systematic review and meta-analysis of studies of the CSF lactate concentration as a marker for both bacterial meningitis and aseptic meningitis was performed. Electronic searches in PubMed, Scopus, the MEDION database and the Cochrane Library were conducted to identify relevant articles published before March 2009. A manual search of reference lists from selected articles was also conducted. Two reviewers independently selected relevant articles and extracted data on study characteristics, quality and accuracy. Twenty-five articles were identified that met the eligibility criteria. Diagnostic odds ratios were considerably homogenous (Chi-square P = 0.1009, I
2
= 27.6%), and the homogeneity was further confirmed by a Galbraith plot and meta-regression analysis using several covariates. The symmetrical summary receiver-operator characteristic curve (SROC), fitted using the Moses-Shapiro-Littenberg method, was positioned near the upper left corner of the SROC curve. The Q value and area under the curve were 0.9451 and 0.9840, respectively, indicating excellent accuracy. The diagnostic accuracy of the CSF lactate concentration was higher than those of other four conventional markers (CSF glucose, CSF/plasma glucose quotient, CSF protein, and CSF total number of leukocytes) using a head to head meta-analysis of the 25 included studies. To distinguish bacterial meningitis from aseptic meningitis, CSF lactate is a good single indicator and a better marker compared to other conventional markers.
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Citations
2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis.
Allan R. Tunkel,Rodrigo Hasbun,Adarsh Bhimraj,Karin E. Byers,Sheldon L. Kaplan,W. Michael Scheld,Diederik van de Beek,Thomas P. Bleck,Hugh J. L. Garton,Joseph R. Zunt +9 more
TL;DR: These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.
806
ESCMID guideline: diagnosis and treatment of acute bacterial meningitis.
D. van de Beek,C Cabellos,Olga Dzupova,Susanna Esposito,Matthias Klein,Anne T. Kloek,Stephen L. Leib,Bruno Mourvillier,Christian Østergaard,Pasquale Pagliano,Hans-Walter Pfister,Robert C. Read,O Resat Sipahi,Mieke C. Brouwer +13 more
TL;DR: The ESCMID Study Group for Infections of the Brain (ESGIB) is a large-scale, randomized, placebo-controlled study that aims to provide real-time information on the safe and effective use of antibiotics in the treatment of central nervous system disorders.
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2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis.
Allan R. Tunkel,Rodrigo Hasbun,Adarsh Bhimraj,Karin E. Byers,Sheldon L. Kaplan,W. Scheld,Diederik van de Beek,Thomas P. Bleck,Hugh J. L. Garton,Joseph R. Zunt +9 more
TL;DR: These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.
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Host Biomarkers for Distinguishing Bacterial from Non-Bacterial Causes of Acute Febrile Illness: A Comprehensive Review
TL;DR: The diagnostic performance of host biomarkers capable of differentiating bacterial from non-bacterial infections to guide the use of antibiotics is summarized to highlight gaps in current knowledge that should be addressed to further improve management of febrile patients.
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TL;DR: The changing pattern and epidemiology of a variety of common central nervous system infections, including meningitis, encephalitis, and brain abscesses are described and pathophysiology and the most current approach to clinical diagnosis, treatment, and disposition from the emergency physician perspective are reviewed.
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