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

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.

• Authors: Sérgio Monteiro de Almeida, Kátia Boritza, Laura Lucia Cogo, Luis Pessa, João França, Indianara Rota, Marisol Muro, Cléa Ribeiro, Sonia Mara Raboni, Luine Rosele Vidal, Meri Bordignon Nogueira, Ronald Ellis
• Journal: Clinical chemistry and laboratory medicine (Clin Chem Lab Med) Vol. 49 Issue 5 Pg. 891-6 (May 2011) ISSN: 1437-4331 [Electronic] Germany
• PMID: 21345043 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Lactic Acid

Topics

• AIDS-Related Opportunistic Infections (cerebrospinal fluid, diagnosis)
• Adolescent
• Adult
• Biomarkers (cerebrospinal fluid)
• Child
• Child, Preschool
• Chronic Disease
• Diagnosis, Differential
• Female
• HIV Infections (complications)
• Humans
• Lactic Acid (cerebrospinal fluid)
• Male
• Meningitis, Viral (cerebrospinal fluid, complications, diagnosis)
• Middle Aged
• Young Adult