163 MEAN ANTIBODY TITRES
(RECIPROCAL)
TO VIRAL ANTIGENS IN
G.N. AND S.L.E.
We think that measurement of
lactic acid, either by method (availenzymatic gas/liquid chromatography able in kit form), is a rapid method providing useful additional or
by
C.S.F.
an
information for the differential diagnosis of meningitis. In our experience, the lactic-acid level was of the greatest value in differentiating tuberculous from viral meningitis, since in most of our cases of M. tuberculosis infection, no organisms were seen in direct smears of the c.s.F., chemical and cellular parameters were not always helpful in diagnosis, and culture takes time.
G.N., and
1/325 in
The patterns for influenza A2 and B and parainfluenza m were the same (see tabled— namely, higher mean antibody titres in G.N. and S.L.E. The antibody titres to parainfluenza i and II in G.N. and S.L.E. were slightly higher, and antibodies titres to adenovirus lower, than in controls. Thus antibody titres to measles, influenza A2 and B, and parainfluenza in in chronic G.N. were significantly higher than in controls, as in s.L.E. I. E. TAREYEVA Laboratory of Nephrology, R. G. FILIMONOVA 1st Moscow Medical Setchenov Institute, M. MAKSUDOVA 119021 Moscow, U.S.S.R., E. CHOLETSKAYA and Institute of Virology, Moscow L. FADEEVA s.L.E.
Department of Microbiology, St Pierre Hospital, 1000 Brussels, Belgium
S. LAUWERS
patients.
LACTIC-ACID CONCENTRATION IN CEREBROSPINAL FLUID AND DIFFERENTIAL DIAGNOSIS OF MENINGITIS
Bf POLYMORPHISM AND ANKYLOSING
SPONDYLITIS
SIR,-Arnason et al. reported their findings of Bf (properdin factor B) polymorphism in anklosing spondylitis (A.s.). They studied 19 Icelandic A.s. patients, all B27-positive, with enough relatives for their HLA and Bf haplotypes to be derived. Surprisingly, all patients carried on the same chromosome the B27 marker and the BP allele. This strong association was not confirmed in 46 B27-positive healthy individuals, only 50% of whom showed this surprising B27/BP haplotype association. We have typed 44 Italian A.s. patients for Bf (all carried the B27 antigen, none were B27 homozygous): 27 had Bf SS, 14 SF, 2 SlS, and 1 FF (see table). Phenotype frequencies of the Bf PHENOTYPES
IN
B27-POSITIVE
A.S. PATIENTS
SIR,-c.s.F. lactic-acid determination is
a useful additional for the early detection of bacterial meningitis, in both untreated and partially treated cases.’-3 In our experience, the c.s.F. lactic acid was above 35 mg/dl in all initial’ c.s.F. specimens from patients with bacterial meningitis, whereas in specimens from patients with viral meningitis, lactic-acid levels have been consistently below 35mg/dl. We have measured c.s.F. lactic acid in all patients admitted to our hospital with a presumptive diagnosis of meningitis for the past two years. Using gas/liquid chromatography we have examined 174 c.s.F. specimens from 118 patients, including 46 cases of bacterial meningitis (16 due to Neisseria meningitidis, 8 to Haemophilus influenza, 7 to Streptococcus pneumoniae, 11 to Mycobacterium tuberculosis, 2 to Listeria monocytogenes, 1 to Strep. agalactiae, and 1 to Staphylococcus aureus; and 20 cases of viral meningitis, 11 of which were proven by C.S.F. culture or by antibody detection in c.s.F. None of these patients had been treated with antibiotics. 52 patients with normal c.s.F. acted as controls. All the controls and viral cases had c.s.F. lactic-acid values lower than 35 mg/dl and all bacterial cases had levels significantly higher than 35 mg/dl, except for 2 patients with meningococcoemia (N. meningitidis group B) with only minor involvement of C.S.F. where we found values of 29 and 31 mg/dl. Further, the c.s.F. lactic acid can be useful in evaluating the response to treatment. In all our cases of pyogenic meningitis with a favourable response to treatment the lactic-acid level fell almost to normal when the second sample of c.s.F. was taken on the 10th day of therapy, whereas in 1 patient who deteriorated clinically a high level persisted. In tuberculous meningitis the c.s.F. lactic acid took several weeks to return to normal. In 2 of these cases neurological complications were reflected by high levels of lactic acid.
diagnostic
1. Brook,
test
I, Bricknell, K. S., Overturf, G. D., Fmegold, S. M. J. infect. Dis. 1978, 137, 384. 2. Controni, G, Rodriguez, W. J., Hicks, J. M., Ficke, M., Ross, S., Friedman, G., Khan, W. J. Pediat. 1977, 91, 379. 3. Ferguson, I. R., Tearle, P. V. J. clin. Path. 1977, 30, 1163.
Bf locus are in the Hardy-Weinberg equilibrium and in good agreement with our control group (X2s=6.30, 0.25
(RECIPROCAL)
TO VIRAL ANTIGENS IN
G.N. AND S.L.E.
We think that measurement of
lactic acid, either by method (availenzymatic gas/liquid chromatography able in kit form), is a rapid method providing useful additional or
by
C.S.F.
an
information for the differential diagnosis of meningitis. In our experience, the lactic-acid level was of the greatest value in differentiating tuberculous from viral meningitis, since in most of our cases of M. tuberculosis infection, no organisms were seen in direct smears of the c.s.F., chemical and cellular parameters were not always helpful in diagnosis, and culture takes time.
G.N., and
1/325 in
The patterns for influenza A2 and B and parainfluenza m were the same (see tabled— namely, higher mean antibody titres in G.N. and S.L.E. The antibody titres to parainfluenza i and II in G.N. and S.L.E. were slightly higher, and antibodies titres to adenovirus lower, than in controls. Thus antibody titres to measles, influenza A2 and B, and parainfluenza in in chronic G.N. were significantly higher than in controls, as in s.L.E. I. E. TAREYEVA Laboratory of Nephrology, R. G. FILIMONOVA 1st Moscow Medical Setchenov Institute, M. MAKSUDOVA 119021 Moscow, U.S.S.R., E. CHOLETSKAYA and Institute of Virology, Moscow L. FADEEVA s.L.E.
Department of Microbiology, St Pierre Hospital, 1000 Brussels, Belgium
S. LAUWERS
patients.
LACTIC-ACID CONCENTRATION IN CEREBROSPINAL FLUID AND DIFFERENTIAL DIAGNOSIS OF MENINGITIS
Bf POLYMORPHISM AND ANKYLOSING
SPONDYLITIS
SIR,-Arnason et al. reported their findings of Bf (properdin factor B) polymorphism in anklosing spondylitis (A.s.). They studied 19 Icelandic A.s. patients, all B27-positive, with enough relatives for their HLA and Bf haplotypes to be derived. Surprisingly, all patients carried on the same chromosome the B27 marker and the BP allele. This strong association was not confirmed in 46 B27-positive healthy individuals, only 50% of whom showed this surprising B27/BP haplotype association. We have typed 44 Italian A.s. patients for Bf (all carried the B27 antigen, none were B27 homozygous): 27 had Bf SS, 14 SF, 2 SlS, and 1 FF (see table). Phenotype frequencies of the Bf PHENOTYPES
IN
B27-POSITIVE
A.S. PATIENTS
SIR,-c.s.F. lactic-acid determination is
a useful additional for the early detection of bacterial meningitis, in both untreated and partially treated cases.’-3 In our experience, the c.s.F. lactic acid was above 35 mg/dl in all initial’ c.s.F. specimens from patients with bacterial meningitis, whereas in specimens from patients with viral meningitis, lactic-acid levels have been consistently below 35mg/dl. We have measured c.s.F. lactic acid in all patients admitted to our hospital with a presumptive diagnosis of meningitis for the past two years. Using gas/liquid chromatography we have examined 174 c.s.F. specimens from 118 patients, including 46 cases of bacterial meningitis (16 due to Neisseria meningitidis, 8 to Haemophilus influenza, 7 to Streptococcus pneumoniae, 11 to Mycobacterium tuberculosis, 2 to Listeria monocytogenes, 1 to Strep. agalactiae, and 1 to Staphylococcus aureus; and 20 cases of viral meningitis, 11 of which were proven by C.S.F. culture or by antibody detection in c.s.F. None of these patients had been treated with antibiotics. 52 patients with normal c.s.F. acted as controls. All the controls and viral cases had c.s.F. lactic-acid values lower than 35 mg/dl and all bacterial cases had levels significantly higher than 35 mg/dl, except for 2 patients with meningococcoemia (N. meningitidis group B) with only minor involvement of C.S.F. where we found values of 29 and 31 mg/dl. Further, the c.s.F. lactic acid can be useful in evaluating the response to treatment. In all our cases of pyogenic meningitis with a favourable response to treatment the lactic-acid level fell almost to normal when the second sample of c.s.F. was taken on the 10th day of therapy, whereas in 1 patient who deteriorated clinically a high level persisted. In tuberculous meningitis the c.s.F. lactic acid took several weeks to return to normal. In 2 of these cases neurological complications were reflected by high levels of lactic acid.
diagnostic
1. Brook,
test
I, Bricknell, K. S., Overturf, G. D., Fmegold, S. M. J. infect. Dis. 1978, 137, 384. 2. Controni, G, Rodriguez, W. J., Hicks, J. M., Ficke, M., Ross, S., Friedman, G., Khan, W. J. Pediat. 1977, 91, 379. 3. Ferguson, I. R., Tearle, P. V. J. clin. Path. 1977, 30, 1163.
Bf locus are in the Hardy-Weinberg equilibrium and in good agreement with our control group (X2s=6.30, 0.25
