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The diagnostic value of cerebrospinal fluid chemistry results in childhood tuberculous meningitis

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Abstract

Purpose

Cerebrospinal fluid (CSF) hypoglycorrhachia and elevated protein is well-described in bacterial meningitis, but evidence for its differential diagnostic value in tuberculous meningitis (TBM) is lacking. We aimed to assess the diagnostic utility of CSF glucose, CSF to serum glucose ratio and CSF protein in children with suspected TBM.

Methods

We describe CSF glucose and protein values as well as CSF to serum glucose ratios in a prospective evaluation of TBM suspects seen at Tygerberg Children’s Hospital, Cape Town, South Africa, from January 1985 to January 2014.

Results

Of 615 TBM suspects, 88 (14 %) had microbiologically confirmed TBM, 381 (62 %) ‘probable’ TBM and 146 (24 %) ‘non-TBM’. Mean absolute CSF glucose concentration was significantly lower in the microbiologically confirmed (1.87 ± 1.15 mmol/L) and ‘probable’ TBM (1.82 ± 1.19 mmol/L) groups compared to non-TBM (3.66 ± 0.88 mmol/L). A CSF glucose concentration of <2.2 mmol/L diagnosed TBM with sensitivity 0.68 and specificity 0.96. Sensitivity using a CSF to serum glucose ratio of <0.5 was 0.90. Mean CSF protein was significantly elevated in the microbiologically confirmed TBM (1.91 ± 1.44 g/L) and ‘probable’ TBM (2.01 ± 1.49 g/L) groups compared to the non-TBM (0.31 ± 0.31 g/L). A CSF protein >1 g/L diagnosed TBM with sensitivity 0.78 and specificity 0.94.

Conclusion

Absolute CSF glucose values of <2.2 mmol/L and protein values of >1 g/L differentiated between TBM and non-bacterial meningitis with good specificity, although sensitivity was poor. A CSF to serum glucose ratio is more informative than the absolute value.

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Funding

This study was supported by a Vrije University-National Research Foundation Desmond Tutu Phd scholarship.

Conflict of interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505, Cape Town, South Africa

    R. S. Solomons, P. R. Donald & J. F. Schoeman

  2. Department of Pediatric Infectious Diseases and Immunology, VU University Medical Center, Amsterdam, The Netherlands

    D. H. Visser & A. M. van Furth

  3. Marie Bashir Infectious Diseases and Biosecurity Institute (MBI) and The Children’s Hospital at Westmead, The University of Sydney, Sydney, Australia

    B. J. Marais

Authors
  1. R. S. Solomons
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  2. D. H. Visser
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  3. P. R. Donald
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  4. B. J. Marais
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  5. J. F. Schoeman
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  6. A. M. van Furth
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Correspondence to R. S. Solomons.

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Solomons, R.S., Visser, D.H., Donald, P.R. et al. The diagnostic value of cerebrospinal fluid chemistry results in childhood tuberculous meningitis. Childs Nerv Syst 31, 1335–1340 (2015). https://doi.org/10.1007/s00381-015-2745-z

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  • DOI: https://doi.org/10.1007/s00381-015-2745-z

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