A common clinical problem concerns the utility of repeat lumbar puncture (LP) in adults with acute bacterial meningitis (ABM), e.g., pneumococcal meningitis [1]. An LP is initially done for diagnostic purposes in patients with suspected ABM, i.e., diagnostic lumbar puncture (DLP). A repeat LP (RLP) may be done 1–3 days after the initial DLP, if the patient shows no improvement. If a patient with ABM is not doing well after three days, adequacy of antimicrobial therapy is the main concern. Other reasons for RLP is to detect possible intracranial complications of ABM unrelated to adequacy of therapy [1–2].
References
[1]
Weisfelt, M.; van de Beek, D.; Spanjaard, L.; Reittsma, J.B.; de Gans, J. Clinical features, complications, and outcome in adults with pneumococcal meningitis: A prospective case series. Lancet Neurol. 2006, 5, 123–129, doi:10.1016/S1474-4422(05)70288-X.
[2]
Denneman, L.; Vial-Dupuy, A.; Gault, N.; Wolff, M.; van de Beek, D.; Mourvillier, B. Repeated lumbar puncture in adults with pneumococcal meningitis: An observational study. J. Infect. 2013, 5, 352–353.
[3]
Brook, I.; Bricknell, K.S.; Overturf, G.D.; Finegold, S.M. Measurement of lactic acid in cerebrospinal fluid of patients with infections of the central nervous system. J. Infect. Dis. 1978, 137, 384–390, doi:10.1093/infdis/137.4.384.
[4]
Bailey, E.M.; Dominico, P.; Cunha, B.A. Bacterial or viral meningitis? Measuring lactate in CSF can help you know quickly. Postgrad. Med. 1990, 88, 217–219.
[5]
Sakushima, K.; Hayashino, Y.; Kaeaguchi, T.; Jackson, J.L.; Fukuhara, S. Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: A meta-analysis. J. Infect. 2011, 62, 255–262, doi:10.1016/j.jinf.2011.02.010.
[6]
Cunha, B.A. The clinical and laboratory diagnosis of acute meningitis and acute encephalitis. Expert Opin. Med. Diagn. 2013, 7, 343–364, doi:10.1517/17530059.2013.804508.
[7]
Cunha, B.A. The diagnosis and therapy of acute bacterial meningitis. In Infection of the Nervous System; Schlossberg, D., Ed.; Springer-Verlag: New York, NY, USA, 1990; pp. 3–24.
