Skip to main content

Meningitis in patients with a Gram-negative direct cerebrospinal fluid examination: the value of cytochemical markers for the differential diagnosis

We read with great interest the article by Viallon and colleagues [1] exploring the value of cytochemical markers for the differential diagnosis of meningitis in patients with a Gram-negative direct cerebrospinal fluid (CSF) examination. We have some concern as regards the confounding factors in their study. Firstly, although lumbar puncture was performed immediately on patient admission, the timepoint to obtain the CSF samples relative to the onset of disease was not uniform. For those patients with a Gram-negative direct CSF examination, the negativity may be attributed to a lumbar puncture at a very early stage. Secondly, the inclusion criteria are ambiguous. Meningitis was defined as a white blood cell count more than 5/mm3 in the CSF. Blood contamination due to the lumbar puncture procedure cannot be ruled out. Moreover, the white blood cell count is insufficient to localize infectious inflammation to cerebral pia mater. In terms of this insufficiency, it is not surprising to see the low incidence of nuchal rigidity [1]. Thirdly, the lack of a gold standard for viral meningitis is a vexing problem. An imperfect standard to evaluate a diagnostic test may lead to distortions in sensitivity and/or specificity [2, 3]. In this regard, a positive group and a negative group are indispensable to determine the sensitivity and specificity of either the serum or the CSF parameters in the differential diagnosis of meningitis. Aseptic meningitis caused by intravenous immunoglobulin has not been excluded, since the causative virus was identified in only 39% of the patients with viral meningitis.

Abbreviations

CSF:

cerebrospinal fluid.

References

  1. Viallon A, Desseigne N, Marjollet O, Birynczyk A, Belin M, Guyomarch S, Borg J, Pozetto B, Bertrand JC, Zeni F: Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis. Crit Care 2011, 15: R136. 10.1186/cc10254

    Article  PubMed Central  PubMed  Google Scholar 

  2. Valenstein PN: Evaluating diagnostic tests with imperfect standards. Am J Clin Pathol 1990, 93: 252-258.

    CAS  PubMed  Google Scholar 

  3. Prasad K, Sahu JK: Cerebrospinal fluid lactate: is it a reliable and valid marker to distinguish between acute bacterial meningitis and aseptic meningitis? Crit Care 2011, 15: 104. 10.1186/cc9396

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hongliang Zhang.

Additional information

Competing interests

The authors declare that they have no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Zhang, H., Wang, X., Yang, Y. et al. Meningitis in patients with a Gram-negative direct cerebrospinal fluid examination: the value of cytochemical markers for the differential diagnosis. Crit Care 15, 439 (2011). https://doi.org/10.1186/cc10320

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/cc10320

Keywords

  • Meningitis
  • White Blood Cell Count
  • Lumbar Puncture
  • Aseptic Meningitis
  • Viral Meningitis