Is Cerebrospinal Fluid C-reactive Protein a Better Tool than Blood C-Reactive Protein in Laboratory Diagnosis of Meningitis in Children ?

Kalpana K Malla,K Seshagiri Rao,Tejesh Malla,Sahisnuta Basnet,Ravi Shah

doi:10.12816/0003201

Abstract

This study aimed to test whether C-reactive protein (CRP) measurement could differentiate between different types of meningitis and become a routine test. A prospective study included 140 children admitted to Manipal Teaching Hospital, Pokhara, Nepal, between July 2009 and June 2011. The subjects had a blood test and detailed cerebrospinal fluid (CSF) analysis, including blood and CSF CRP levels. Of those admitted, 31.1% had pyogenic meningitis (PM), 26.2% partially treated meningitis (PPM), 33% viral meningitis (VM), and 9.7% tubercular meningitis (TBM), with 26.4% controls. Organisms were isolated in 12.5% of the cases by blood culture and 25% of cases through CSF culture. Blood CRP was positive in all groups, with the highest values in PM (53.12 ± 28.88 mg/dl) and PPM (47.55 ± 34.34 mg/dl); this was not statistically significant (P = 0.08). The CSF CRP levels were significantly higher (P <0.001) in PM (45.75 ± 28.50 mg/dl) and PPM (23.11 ± 23.98 mg/dl). The sensitivity and specificity of blood CRP was 90.62%, 88.88%, 64.7%, 70% and 32.4%, 30.97%, 24.52%, 26.12% and that of CSF CRP was 96.87%, 66.66%, 20.58%, 10% and 74.73%, 63.71%, 50.94%, 55.35% for PM, PPM, VM and TBM, respectively. Because of its high sensitivity, both CSF CRP and blood CRP can be used to screen for bacterial meningitis (both PM and PPM). CSF CRP screening yielded results with a higher specificity than blood CRP; hence, it can be a supportive test along with CSF cytology, biochemistry, and microbiology for diagnosing meningitis.

Highlights

‫) في السائل الدماغي الشوكي‬C-reactive protein (CRP)) C ‫هل فحص البروتين الفعال‬ ‫أفضل من فحصه في الدم لتشخيص مرض السحايا في الأطفال مخبريا‬
Advances in Knowledge - Blood and cerebrospinal fluid (CSF) C-reactive protein (CRP) can be a simple bedside test to differentiate between different types of meningitis. - Both can be especially helpful in diagnosing partially treated meningitis when patients present after being prescribed antibiotics, and the CSF picture is similar to viral meningitis
Organisms isolated in CSF were E. coli, which was isolated in two samples; Enterococcus, which was isolated in one sample; Staphylococcus aureus, which was isolated in two samples; Pseudomonas was isolated in one sample; and Streptococcus pneumonia, which was isolated in two samples (8/32, 25%) [Table 2]

Summary

Introduction

‫) في السائل الدماغي الشوكي‬CRP) C ‫هل فحص البروتين الفعال‬ ‫أفضل من فحصه في الدم لتشخيص مرض السحايا في الأطفال مخبريا‬. Advances in Knowledge - Blood and cerebrospinal fluid (CSF) C-reactive protein (CRP) can be a simple bedside test to differentiate between different types of meningitis. The CSF Gram stain and culture still remains the gold standard in the diagnosis of meningitis, but in patients where these results are negative, there is no definitive test for diagnosing meningitis This is especially necessary in a set up like ours where patients come after getting various antibiotics or where facilities for doing cultures are not readily available. The present study was designed to evaluate the diagnostic significance of CRP in CSF and blood as a rapid and simple method of diagnosing and differentiating different types of meningitis in children in a developing country like Nepal where there is a problem in isolating organisms

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