New and old diagnostic markers of meningitis in cerebrospinal fluid (CSF)

Five new markers (tumor necrosis factor TNF-alpha, interleukin IL-1beta, IL-6, IL-8, lipopolysaccharide binding protein (LBP)) and 11 old classical markers were evaluated in 180 cerebrospinal fluid (CSF) and serum pairs to discriminate acute bacterial meningitis (BM) on admission from aseptic (viral) meningitis (AM), bacterial meningitis treated with antibiotics (TM) from AM, and AM from multiple sclerosis (MS). Statistical tests were computed which classified correctly greater than or equal to90% of the patients with BM, TM, AM at a sum minimum of false positive plus false negative results, and which reached additionally greater than or equal to90% sensitivity and specificity. To discriminate BM from AM, CSF IL-6 test greater than or equal to500 ng/l and CSF IL-1beta test greater than or equal to8 ng/l besides CSF lactate test greater than or equal to3.5 mmol/l and CSF granulocyte test greater than or equal to150 mmol/l were revealed. CSF lactate test greater than or equal to3.2 mmol/l discriminated TM from AM. CSF leukocyte test greater than or equal to35 M/l discriminated AM from MS. Tests with the new markers were more laborious, expensive, and time consuming compared to CSF lactate test. Test candidates, detecting greater than or equal to 80% of patients with greater than or equal to 80% sensitivity and specificity, were evaluated with CSF TNF-alpha, IL-8 and LBP, serum IL-6, CSF leukocytes, lymphocytes and monocytes, Qglucose, CSF total protein, albumin, and Qalbumin. All tests should be reviewed in context of clinical findings to diagnose BM reliably. (C) 2003 Elsevier Science Inc. All rights reserved.