Diagnostic and Prognostic Value of Cerebrospinal Fluid Lactate and Glucose in HIV-Associated Tuberculosis Meningitis
Edwin Nuwagira, Kathy Huppler Hullsiek, Samuel Jjunju, Morris K Rutakingirwa, John Kasibante, Kiiza Kandole Tadeo, Enock Kagimu, Lillian Tugume, Kenneth Ssebambulidde, Abdu K Musubire, Ananta Bangdiwala, Conrad Muzoora, David B. Meya, David R. Boulware, Nathan C. Bahr, Fiona V. Creswell
Abstract
Tuberculosis meningitis (TBM) is the most severe form of tuberculosis, and its fatality is largely due to delays in diagnosis. The role of CSF lactate has not been evaluated in patients with HIV presenting with signs and symptoms of meningitis. In this study, using a point-of-care handheld lactate machine in patients with HIV-associated meningitis, we showed that high baseline CSF lactate (>5.5 mmol) may be used to rapidly identify patients with TBM and shorten the time to initiate treatment with a similar performance to the Xpert Ultra assay for definite TBM. Elevated CSF lactate levels, however, were not associated with increased 2-week mortality in patients with HIV-associated TBM. Due to moderate specificity, other etiologies of meningitis should be investigated.