title: Cerebrospinal fluid lactate dehydrogenase isoenzymes in children with bacterial and aseptic meningitis.
abstract: Differentiation of bacterial from aseptic meningitis may be difficult. Our aim was to determine the pattern of distribution of lactate dehydrogenase (LDH) isoenzymes in the cerebrospinal fluid (CSF) of patients with bacterial and aseptic meningitis. One hundred and fifty-seven patients with suspected meningitis were enrolled in the study. They were divided into 3 groups according to the culture- or bacterial antigen assay-proven diagnosis and CSF findings: bacterial meningitis (n = 31), aseptic meningitis (n = 65), and non-meningitis (n = 61). Total LDH level and percentages of LDH isoenzymes in the CSF were measured in each patient. Each group showed a distinct LDH isoenzyme distribution pattern, with a statistically significant difference among the groups in the percentages of the various isoenzymes. Compared with the non-meningitis group, total LDH activity in the CSF was high in the aseptic meningitis group (49.82+/-35.59 U/L, P < 0.001) and exaggerated in the bacterial meningitis group (944.53+/-112.3 U/L, P < 0.001). Low LDH-2 levels were unique to bacterial meningitis (P < 0.01), whereas high LDH-3 levels were characteristic of aseptic meningitis (P < 0.05). Both groups had low levels of LDH-1 and high levels of LDH-4 and LDH-5. In conclusion, the LDH isoenzyme pattern may be of clinical diagnostic value in meningitis, particularly when culture results are pending.
authors.affiliation: Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. nussim@clalit.org.il
authors.forename: Moshe
authors.initials: M
authors.lastname: Nussinovitch
authors.forename: Yaron
authors.initials: Y
authors.lastname: Finkelstein
authors.forename: Keren Politi
authors.initials: KP
authors.lastname: Elishkevitz
authors.forename: Benjamin
authors.initials: B
authors.lastname: Volovitz
authors.forename: Daniella
authors.initials: D
authors.lastname: Harel
authors.forename: Gil
authors.initials: G
authors.lastname: Klinger
authors.forename: Yaron
authors.initials: Y
authors.lastname: Razon
authors.forename: Udi
authors.initials: U
authors.lastname: Nussinovitch
authors.forename: Naomi
authors.initials: N
authors.lastname: Nussinovitch
mesh_terms: D000293:Adolescent; D001826:Body Fluids / Q000201:enzymology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007527:Isoenzymes / Q000134:cerebrospinal fluid; D007770:L-Lactate Dehydrogenase / Q000134:cerebrospinal fluid*; D008582:Meningitis, Aseptic / Q000134:cerebrospinal fluid* / Q000145:classification / Q000201:enzymology*; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid* / Q000145:classification / Q000201:enzymology*; D018579:Patient Selection
chemical_list: D007527:Isoenzymes; D007770:L-Lactate Dehydrogenase