Evaluation of enzymes in pyogenic and tuberculous meningitis.

OBJECTIVES Lactic dehydrogenase (LDH), creatine kinase (CK) and gamma glutamyl transpeptidase (GGTP) were measured serially in cerebrospinal fluid (CSF) and serum in twenty five cases of meningitis and an equal number of age and sex matched healthy control subjects with an aim to find out their diagnostic and prognostic significance in cases of meningitis. METHODS The enzymatic activity was measured serially (day 0, 4th and 7th) in cerebrospinal fluid (CSF) and serum in twenty-five cases of meningitis consisting of fifteen cases of pyogenic meningitis (PM) and ten of tuberculous meningitis (TBM) and an equal number of age and sex matched healthy control. The clinical details including the level of consciousness and neurological deficit were correlated with the enzymatic activity and prognosis. RESULTS The levels of these enzymes were significantly elevated in all the cases of meningitis in serum as well as CSF as compared to control subjects. The activity was significantly higher in pyogenic than tuberculous meningitis (p<0.001) and it was higher in CSF than in serum (p<0.001). The maximum elevation in activity of GGTP and LDH were seen on the first day whereas CK was highest on 4th day and thereafter, the activity of all the enzymes declined in the majority of cases who had shown clinical improvement. However, in three cases of pyogenic and five cases of tuberculous meningitis, the enzymatic activity on subsequent estimation, increased serially. All these eight cases died. Further, the basal enzymatic activity in all these eight cases that died was higher as compared to those who survived. Of all the enzymes, CSF GGTP levels correlated best with the clinical picture. CONCLUSIONS It is concluded that GGTP, CK and LDH were significantly elevated in cases of meningitis. It was not possible to differentiate the type of meningitis on the basis of enzymatic activity in any of them. However, it was possible to predict prognosis because higher basal activity and serial rise were associated with poor prognosis.