AIM: To evaluate the diagnostic performance of cerebrospinal fluid (CSF) lactate as a potential biomarker for differentiation of scrub typhus from other causes of acute meningitis. MATERIALS AND METHODS: In this prospective observational study, we recruited 113 consecutive patients admitted with acute meningitis at a university teaching hospital in India between August, 2014 and August, 2016. Patients were divided into four etiological groups – scrub typhus, bacterial tuberculous (TB) and viral. We analyzed and compared the CSF lactate in addition to clinical, laboratory and CSF parameters between these groups. The diagnostic accuracy of CSF lactate was assessed using receiver operating characteristic (ROC) curve. RESULTS: 33 cases of scrub typhus, 26 cases of bacterial meningitis, 26 cases of TB meningitis and 28 cases of viral meningitis were included in the analysis. CSF lactate levels were significantly different in scrub (3.52 ± 1.87 mmol/l) vs. bacterial (7.98 ± 6.04 mmol/l), tuberculous (5.75 ± 2.67 mmol/l) and aseptic (2.63 ± 0.93 mmol/l) meningitis (p<0.001). ROC curve analysis showed that a CSF lactate cut-off point of 2.9 mmol/l had a sensitivity of 52% (95% CI 34-69%), specificity of 68% (95% CI 48-84%), positive predictive value of 65% (95% CI 44-83%) and negative predictive value of 54% (95% CI 37-71%) for differentiation of scrub typhus from viral meningitis. Other CSF parameters (CSF white cell counts, protein and glucose) were also significantly different between the groups (p<0.05 for all comparisons). CONCLUSION: Our findings suggest that CSF lactate is a rapid, reliable and cost-effective test for the differential diagnosis of various CNS infections; and should be used in combination with conventional CSF parameters in the initial diagnostic work-up of acute meningitis. KEYWORDS: Scrub typhus, Meningitis, Meningoencephalitis, Lactic acid, CSF Lactate
A150 LONG TERM EFFECTS OF HIGH BIRTH WEIGHT ON CHILDHOOD HEALTH STATUS IN SOUTH INDIA Ahikam Devadason J1, Annarani Jose1, Anu Anna Binny1, Arjun Ambat1, Deepa Susan Thomas1, Divya Bennet1, Julie Jacob1, Namrata Mathew1, Rahul Jaic Sam1, Rebecca Mridula Singh1,
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7th Annual Research Day