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Role of cerebrospinal fluid lactate dehydrogenase and creatine phosphokinase in the differential diagnosis of bacterial, viral, and tubercular meningitis

Ankur Banik, Sourish Chatterjee, Milan Chakraborty.


Background: Meningitis is a common clinical problem, caused by various bacteria and viruses. Its etiology needs to be ascertained swiftly to institute appropriate therapy to prevent morbidity and mortality. In some cases, the precise etiological diagnosis cannot be ascertained in spite of thorough work up.

Objectives: The present study was a prospective study undertaken in cases of meningitis admitted in the Medicine Ward of Burdwan Medical College and Hospital to determine the levels of cerebrospinal fluid (CSF) lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) concentration and their possible roles in the etiological diagnosis of different kinds of meningitis.

Materials and Methods: A prospective study was conducted on 150 patients, 50 patients of each of bacterial, viral, and tubercular meningitis, admitted in the Medicine Ward of Burdwan Medical College and Hospital. The values of CSF CPK, and LDH were calculated for each patient and variation of means was analyzed by appropriate biomedical software. The SPSS for the Windows 20.0 statistical package program has been used in the evaluation of the data. The quantitative data of the groups were compared using ANOVA with post hoc test for comparison. P < 0.05 was considered statistically significant.

Results: It was found that CSF LDH, and CPK were significantly elevated in pyogenic meningitis and tubercular meningitis as compared to viral meningitis. The differences between the CSF LDH, and CSF-CPK values in differentiating any one of the three forms against another were found to be statistically significant.

Conclusion: Thus, CSF CPK and LDH may serve as an useful marker for differentiation of etiology of meningitis at least in conjunction with the classical CSF markers and especially in the doubtful cases.

Key words: Meningitis; Creatine Phosphokinase; Lactate Dehydrogenase

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