title: Utility of cerebrospinal fluid cortisol level in acute bacterial meningitis.
abstract: BACKGROUND
  Meningitis remains a serious clinical problem in developing as well as developed countries. Delay in diagnosis and treatment results in significant morbidity and mortality. The role and levels of intrathecal endogenous cortisol is not known.
  
  
  OBJECTIVE
  To study the cerebrospinal fluid (CSF) cortisol levels and to evaluate its role as a diagnostic and therapeutic marker in acute bacterial meningitis.
  
  
  METHODS
  Thirty patients with acute bacterial meningitis with no prior treatment were evaluated. Cortisol levels were compared with 20 patients with aseptic (viral) meningitis and 25 control subjects.
  
  
  RESULTS
  Mean CSF cortisol level was 13.85, 3.47, and 1.05 in bacterial meningitis, aseptic meningitis, and controls, respectively. Mean CSF cortisol level in bacterial meningitis was significantly higher as compared to controls (P < 0.001). There was significant difference in CSFcortisol levels in bacterial and aseptic meningitis (P < 0.001).
  
  
  CONCLUSIONS
  Cortisol levels in CSF are highly elevated in patients with acute bacterial meningitis. This suggests that intrathecalcortisol may serve as a valuable, rapid, relatively inexpensive diagnostic marker in discriminatingbetween bacterial and aseptic meningitis. This helps in earlier institution of appropriate treatment and thereby decreasing morbidity and mortality.
authors.affiliation: Department of Neurology, MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India.
authors.forename: Anish
authors.initials: A
authors.lastname: Mehta
authors.affiliation: Department of Neurology, MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India.
authors.forename: Rohan R
authors.initials: RR
authors.lastname: Mahale
authors.affiliation: Department of Medicine, MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India.
authors.forename: Uchil
authors.initials: U
authors.lastname: Sudhir
authors.affiliation: Department of Neurology, MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India.
authors.forename: Mahendra
authors.initials: M
authors.lastname: Javali
authors.affiliation: Department of Neurology, MS Ramaiah Medical College and Hospital, Bangalore, Karnataka, India.
authors.forename: Rangasetty
authors.initials: R
authors.lastname: Srinivasa
keywords: Aseptic meningitis; CSF; bacterial meningitis; cortisol; diagnostic; therapeutic