Microbial aspects and potential markers for differentiation between bacterial and viral meningitis among adult patients.

Sultan F Alnomasy,Bader S Alotaibi,Mohamed E Ali,Ahmed H Mujamammi,Elham A Hassan,Ray Borrow

doi:10.1371/journal.pone.0251518

Sultan F Alnomasy, Bader S Alotaibi + Show 4 more

Open Access

https://doi.org/10.1371/journal.pone.0251518

Copy DOI

Abstract

ObjectivesMeningitis is a medical emergency with permanent disabilities and high mortality worldwide. We aimed to determine causative microorganisms and potential markers for differentiation between bacterial and viral meningitis.MethodologyAdult patients with acute meningitis were subjected to lumber puncture. Cerebrospinal fluid (CSF) microorganisms were identified using Real-time PCR. PCT and CRP levels, peripheral and CSF-leucocyte count, CSF-protein and CSF-glucose levels were assessed.ResultsOut of 80 patients, infectious meningitis was confirmed in 75 cases; 38 cases were bacterial meningitis, 34 cases were viral meningitis and three cases were mixed infection. Higher PCT, peripheral and CSF-leukocytosis, higher CSF-protein and lower CSF-glucose levels were more significant in bacterial than viral meningitis patients. Neisseria meningitides was the most frequent bacteria and varicella-zoster virus was the most common virus. Using ROC analyses, serum PCT and CSF-parameters can discriminate bacterial from viral meningitis. Combined ROC analyses of PCT and CSF-protein significantly improved the effectiveness in predicting bacterial meningitis (AUC of 0.998, 100%sensitivity and 97.1%specificity) than each parameter alone (AUC of 0.951 for PCT and 0.996 for CSF-protein).ConclusionCSF-protein and serum PCT are considered as potential markers for differentiating bacterial from viral meningitis and their combination improved their predictive accuracy to bacterial meningitis.

Highlights

Infectious meningitis is one of the major lethal infections of the central nervous system causing 422,900 deaths and 2628,000 patients with disabling sequelae globally [1]
Out of 80 patients, infectious meningitis was confirmed in 75 cases; 38 cases were bacterial meningitis, 34 cases were viral meningitis and three cases were mixed infection
Using receiver operating characteristic (ROC) analyses, serum PCT and Cerebrospinal fluid (CSF)-parameters can discriminate bacterial from viral meningitis

Summary

Introduction

Infectious meningitis is one of the major lethal infections of the central nervous system causing 422,900 deaths and 2628,000 patients with disabling sequelae globally [1]. Antibiotic therapy and good care facilities, the mortality and morbidity rates of bacterial meningitis are still high in both developing and developed countries. It is not always possible to differentiate between bacterial and viral meningitis that contributes to excessive empirical use of antibiotics leading to increase their resistance [7]. Early differentiation between bacterial and viral meningitis, including higher index of suspicion of infection, and the clarification of diagnostic criteria, together with appropriate antibiotic use, have greatly improved the prognosis of these patients, and reduced mortality [5]

Objectives

Methods

Results

Conclusion