Clinical implications of lactic acidosis in purulent meningitis

: Lactic acidosis is an integral index of metabolic disturbances and severity of inflammation processes. This study was designed to measure lactate levels in blood and cerebrospinal fluid (CSF), CSF/blood lactate ratio, correlation coefficient between CSF lactate and other CSF parameters in patients with purulent meningitis of different etiology. The study included 112 patients (62 men and 50 women aged 18-70 years) admitted to No2 City Hospital, Moscow, for the treatment of meningococcal and pneumococcal meningitis (40 and 23 respectively), purulent meningitis of unknown etiology (22), staphylococcal sepsis with secondary purulent meningitis (11), serous viral meningitis (9), and non-inflammatory lesions of central nervous system (control group of 7patients). Blood and CSF lactate levels were measured on admittance, days 3- 7and 8-18 after the initiation of therapy. CSF lactate was especially high in patients with primary purulent meningitis having lower blood lactate levels. Patients with sepsis and secondary purulent meningitis had higher lactate levels in plasma than in CSF on admittance and days 8-18 after the onset of therapy; this situation reflects a generalized infectious process. CSF lactate positively correlated with protein content and pleocytosis intensity in the liquor and negatively with the glucose level. Prognosis of the disease depended on the efficiency of antibacterial therapy.