579 SUMMARY OF TREATMENT AND SIDE-EFFECTS
test for confirmation of be recommended.
logical
a
clinical
diagnosis
should
not
Department of Preventive Medicine, New York State College of
Veterinary Medicine, Cornell University
Ithaca, N.Y. 14853, U.S.A.
RAYMOND H. CYPESS LAWRENCE T. GLICKMAN
LACTIC-ACID CONCENTRATION IN CEREBROSPINAL FLUID AND DIFFERENTIAL DIAGNOSIS OF MENINGITIS
*Or carbidopa/levodopa.
maximum daily doses of 1.5g levodopa, 500 mg carbidopa/ levodopa, and 30 mg anticholinergics (methixene and trihexyphenidyl). With bromocriptine therapy we have been able to keep the daily dose unchanged for 24-30 months;with other antiparkinsonian agents doses often have to be increased to maintain therapeutic efficacy. In twenty-two patients receiving long-term therapy (including all those on bromocriptine as sale medication) we checked -
blood counts, liver function, and urine every 2-4 months, and in twenty-one patients we took electrocardiographic tracings every 6 months. No drug-related changes were found. Neurologische Universitätsklinik, H. P. LUDIN
3010 Berne, Switzerland and Medical Research,
Biological Experimental Therapeutics, Sandoz Ltd., Basle
E. RINGWALD
Privatambulatorium Dr. Faderl,
Neuenburg am Rhein, Germany
P. LORINCZ
SIR,-Dr Lauwers (July 15, p. 163) commented on the value of cerebrospinal-fluid (c.s.F.) lactic-acid estimation in the differential diagnosis of meningitis. In clinical practice there are two problem areas where the need for such a test may arlise-in partly treated bacterial meningitis, which causes diagnostic confusion only occasionally,’ and in the differentiation of smear-negative cases of tuberculous meningitis from virus meningitis. The radioactive bromide partition test2 is quite helpful here but there is a delay of several days before the results are available. We have used an enzymatic method (test-combination lactate kit, Boehringer Mannheim) to determine the lactate concentration in c.s.F. This kit is intended for the estimation of blood-lactate and an essential step is to remove protein with ice-cold perchloric acid. Although C.S.F. without added preservative has been used for lactate estimation by gas-liquid chromatography34 we have assumed that it is necessary to stabilise the lactate in c.s.F. Bland et a1.5 used perchloric acid for this ,
1. Mandal, B. K. Scand.J. infect. Dis. 1976, 8, 185. 2. Mandal, B. K., Evans, D. I. K., Ironside, A. G., Pullan, B. R. Br.
SEROLOGICAL TESTS FOR TOXOCARA
SIR,-In their letter on human Toxocara infection in West Scotland Girdwood et al.noted that the prevalence of human infection and disease attributable to T. canis is controversial. In attempt to clarify the issue they used a larval secretory antigen to measure the seroprevalence of infection in healthy individuals and patients. In the rabbit this antigen had been found to be "sensitive and specific" and "there were no crossreactions between experimentally induced visceral larva migrans of T. canis, Toxascaris leonina. A. lumbricoides, and A. suum origins", on counterimmunoelectrophoresis, indirect fluorescence, and radioimmunoassay. The cross-section problem is more complex than this, hówever, and we question the validity of their results in human populations. Ascarid antigens may cross-react not only with each other but also with several proteins found in human sera, including C-reactive protein, rheumatoid factor, and heterophile antibody.2 For this reason, we have found it necessary to absorb human serum with embryonated egg antigens of Ascaris suum before testing with embryonated egg antigens of T. canis.2 With this step incorporated the enzyme-linked immunosorbent assay (ELISA) was 78% sensitive and 92% specific.3 If the sensitivity and specificity of a test.are known, the apparent prevalence of infection can be adjusted statistically to reflect the true prevalence.4 Unless the sensitivity and specificity are determined in a human population, the use of a sero1. Girdwood, R. W. A.,
Smith,
H. V.,
Bruce,
R.
G., Quinn, R. Lancet, 1978,
i,1318 2. Cypess, R. H., Karol, M. H., Zidian, J. L., Glickman, L. T., Gitlin, D., J. infect. Dis. 1977, 135, 633. 3. Glickman, L., Schantz, P., Dombroske, R., Cypess, R. H Am. J. trop. Med.
Hyg 1975, 27, 492. 4.
Rogan, W.J, Gladen, B. Am.J. Epid.1978,107, 71.
med. J.
1972, iv, 413. 3. Ferguson, I. R., Tearle, P. V.J. clin. Path. 1977, 30, 1163. 4. Controni, G., Rodriguez, W. J., Hicks, J. M., Ficke, M., Ross, S., Friedman, G., Khan, W.J. Pediat. 1977, 91, 379. 5. Bland, R. D., Lister, R. C., Ries, J. P. Am. J. Dis. Child. 1974, 128, 151.
C.S.F.-lactate in meningitis
test for confirmation of be recommended.
logical
a
clinical
diagnosis
should
not
Department of Preventive Medicine, New York State College of
Veterinary Medicine, Cornell University
Ithaca, N.Y. 14853, U.S.A.
RAYMOND H. CYPESS LAWRENCE T. GLICKMAN
LACTIC-ACID CONCENTRATION IN CEREBROSPINAL FLUID AND DIFFERENTIAL DIAGNOSIS OF MENINGITIS
*Or carbidopa/levodopa.
maximum daily doses of 1.5g levodopa, 500 mg carbidopa/ levodopa, and 30 mg anticholinergics (methixene and trihexyphenidyl). With bromocriptine therapy we have been able to keep the daily dose unchanged for 24-30 months;with other antiparkinsonian agents doses often have to be increased to maintain therapeutic efficacy. In twenty-two patients receiving long-term therapy (including all those on bromocriptine as sale medication) we checked -
blood counts, liver function, and urine every 2-4 months, and in twenty-one patients we took electrocardiographic tracings every 6 months. No drug-related changes were found. Neurologische Universitätsklinik, H. P. LUDIN
3010 Berne, Switzerland and Medical Research,
Biological Experimental Therapeutics, Sandoz Ltd., Basle
E. RINGWALD
Privatambulatorium Dr. Faderl,
Neuenburg am Rhein, Germany
P. LORINCZ
SIR,-Dr Lauwers (July 15, p. 163) commented on the value of cerebrospinal-fluid (c.s.F.) lactic-acid estimation in the differential diagnosis of meningitis. In clinical practice there are two problem areas where the need for such a test may arlise-in partly treated bacterial meningitis, which causes diagnostic confusion only occasionally,’ and in the differentiation of smear-negative cases of tuberculous meningitis from virus meningitis. The radioactive bromide partition test2 is quite helpful here but there is a delay of several days before the results are available. We have used an enzymatic method (test-combination lactate kit, Boehringer Mannheim) to determine the lactate concentration in c.s.F. This kit is intended for the estimation of blood-lactate and an essential step is to remove protein with ice-cold perchloric acid. Although C.S.F. without added preservative has been used for lactate estimation by gas-liquid chromatography34 we have assumed that it is necessary to stabilise the lactate in c.s.F. Bland et a1.5 used perchloric acid for this ,
1. Mandal, B. K. Scand.J. infect. Dis. 1976, 8, 185. 2. Mandal, B. K., Evans, D. I. K., Ironside, A. G., Pullan, B. R. Br.
SEROLOGICAL TESTS FOR TOXOCARA
SIR,-In their letter on human Toxocara infection in West Scotland Girdwood et al.noted that the prevalence of human infection and disease attributable to T. canis is controversial. In attempt to clarify the issue they used a larval secretory antigen to measure the seroprevalence of infection in healthy individuals and patients. In the rabbit this antigen had been found to be "sensitive and specific" and "there were no crossreactions between experimentally induced visceral larva migrans of T. canis, Toxascaris leonina. A. lumbricoides, and A. suum origins", on counterimmunoelectrophoresis, indirect fluorescence, and radioimmunoassay. The cross-section problem is more complex than this, hówever, and we question the validity of their results in human populations. Ascarid antigens may cross-react not only with each other but also with several proteins found in human sera, including C-reactive protein, rheumatoid factor, and heterophile antibody.2 For this reason, we have found it necessary to absorb human serum with embryonated egg antigens of Ascaris suum before testing with embryonated egg antigens of T. canis.2 With this step incorporated the enzyme-linked immunosorbent assay (ELISA) was 78% sensitive and 92% specific.3 If the sensitivity and specificity of a test.are known, the apparent prevalence of infection can be adjusted statistically to reflect the true prevalence.4 Unless the sensitivity and specificity are determined in a human population, the use of a sero1. Girdwood, R. W. A.,
Smith,
H. V.,
Bruce,
R.
G., Quinn, R. Lancet, 1978,
i,1318 2. Cypess, R. H., Karol, M. H., Zidian, J. L., Glickman, L. T., Gitlin, D., J. infect. Dis. 1977, 135, 633. 3. Glickman, L., Schantz, P., Dombroske, R., Cypess, R. H Am. J. trop. Med.
Hyg 1975, 27, 492. 4.
Rogan, W.J, Gladen, B. Am.J. Epid.1978,107, 71.
med. J.
1972, iv, 413. 3. Ferguson, I. R., Tearle, P. V.J. clin. Path. 1977, 30, 1163. 4. Controni, G., Rodriguez, W. J., Hicks, J. M., Ficke, M., Ross, S., Friedman, G., Khan, W.J. Pediat. 1977, 91, 379. 5. Bland, R. D., Lister, R. C., Ries, J. P. Am. J. Dis. Child. 1974, 128, 151.
C.S.F.-lactate in meningitis
