Childhood bacterial meningitis and usefulness of C-reactive protein

Abstract

Background: C-reactive protein raises rapidly in the first 24–48 hours of occurrence of bacterial meningitis and in large incremental increases thereafter. This prospective study was undertaken in a tertiary care hospital of Armed Forces to ascertain the usefulness of C-reactive protein in early diagnosis of bacterial meningitis. Methods: All children admitted during the period of study, with clinical suspicion of meningitis were clinically, biochemically, cytologically and bacteriologically investigated to clinch the diagnosis. Blood and CSF were also sent for C-reactive protein assay by latex agglutination test. CSF gram staining, culture and biochemical results were taken as gold standard. CSF and serum CRP were then evaluated against this gold standard. Statistical analysis was done by Epiinfo 6. Results: There were 63 cases of meningitis admitted in the hospital. By gold standard, there were 38 cases of bacterial, 21 cases of tubercular and 4 cases of viral meningitis. H. influenza was the predominant organism grown. CSF C-reactive protein was raised in 33 cases of bacterial and 2 cases of tubercular meningitis. Serum C-reactive protein was raised in 29 cases of bacterial, and eight cases of tubercular meningitis. These tests were negative in all cases of viral meningitis. The sensitivity and specificity of serum and CSF C-reactive protein was 96% and 100%. Conclusion: Quantitative and qualitative assay of C-reactive protein is a simple bedside test. It can be completed in 10 minutes and requires only 0.2 ml of blood. This will significantly reduce unnecessary antibiotics to children.