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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

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IMPACT FACTOR 2016: 3.432

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1437-4331
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Volume 49, Issue 5 (May 2011)

Issues

Quantification of cerebrospinal fluid lactic acid in the differential diagnosis between HIV chronic meningitis and opportunistic meningitis

Sérgio Monteiro de Almeida
  • Virology Section, Clinical Pathology Laboratory, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
  • CSF Section, Clinical Pathology Laboratory, Hospital de Clínicas, Federal University of Paraná, Brazil
  • Pelé Pequeno Principe Research Institute, Curitiba, Brazil
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/ Kátia Boritza
  • Biochemistry Section, Clinical Pathology Laboratory, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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/ Laura Lucia Cogo
  • Bacteriology Section, Clinical Pathology Laboratory, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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/ Luis Pessa
  • Virology Section, Clinical Pathology Laboratory, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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/ João França
  • Infectious Disease Unity, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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/ Indianara Rota
  • Virology Section, Clinical Pathology Laboratory, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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/ Marisol Muro
  • Mycology Section, Clinical Pathology Laboratory, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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/ Cléa Ribeiro
  • Infectious Disease Unity, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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/ Sonia Mara Raboni
  • Virology Section, Clinical Pathology Laboratory, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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/ Luine Rosele Vidal
  • Virology Section, Clinical Pathology Laboratory, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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/ Meri Bordignon Nogueira
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/ Ronald Ellis
Published Online: 2011-02-11 | DOI: https://doi.org/10.1515/CCLM.2011.131

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

About the article

Corresponding author: Sérgio Monteiro de Almeida, MD, PhD, Hospital de Clínicas, UFPR, Seção de Virologia, Setor Análises Clínicas, Rua Padre Camargo, 280, Curitiba, PR, 80060-240, Brazil Phone/Fax: +55 (41) 3360-7974


Received: 2010-08-06

Accepted: 2010-11-25

Published Online: 2011-02-11

Published in Print: 2011-05-01


Citation Information: Clinical Chemistry and Laboratory Medicine, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2011.131.

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©2011 by Walter de Gruyter Berlin New York. Copyright Clearance Center

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