Abstract
BackgroundBacterial meningitis is a paediatric emergency with high mortality and morbidity requiring prompt diagnosis and treatment. Clinically, it is often difficult to differentiate between bacterial and non-bacterial meningitis. Several studies have demonstrated the raised values of serum procalcitonin (PCT) in bacterial infections including meningitis but without definite cut-off guidelines. Hence, this study was done to evaluate serum PCT as a marker to differentiate bacterial and non-bacterial meningitis in children and assess its efficacy.MethodsIt was a cross-sectional study done over a period of 5 months (Aug 2016-Dec 2016) in the department of Paediatrics, B P Koirala Institute of Health Sciences (BPKIHS). Fifty children aged 3 months to 15 years with suspected meningitis were enrolled and investigated with relevant investigations like complete blood counts, and cerebrospinal fluid (CSF) analysis along with serum PCT. Patients were classified into bacterial (22) and non-bacterial meningitis (28) according to clinical & CSF findings and data analysed using SPSS software.ResultsSerum PCT levels were significantly higher in bacterial meningitis group (median = 2.04 (1.2–3.18) ng/ml) compared with non-bacterial meningitis (median = 0.35 (0.18–0.35) ng/ml); p < 0.001. The sensitivity and specificity of serum PCT in diagnosis of bacterial meningitis at cut-off level of 0.5 ng/ml were 95.45% and 84.61% respectively. Procalcitonin showed maximum area under receiver operating characteristics (ROC) curve 0.991 (0.974–1.00) (p < 0.001) compared to total leukocyte count and CSF cytochemistry.ConclusionSerum PCT has high sensitivity and specificity for early diagnosis of bacterial meningitis in children. Hence it can be a useful adjunct in differentiating bacterial and non-bacterial meningitis for prompt and better management of the children.
Highlights
Bacterial meningitis is a paediatric emergency with high mortality and morbidity requiring prompt diagnosis and treatment
Cerebrospinal fluid (CSF) analysis has been considered the gold standard for diagnosing bacterial meningitis, along with biomarkers like C-reactive protein (CRP) and white blood cell count (WBC) [2]
Amongst the 50 patients enrolled in this study, 22 patients fulfilled the criteria for bacterial meningitis and 28 patients non-bacterial meningitis
Summary
Bacterial meningitis is a paediatric emergency with high mortality and morbidity requiring prompt diagnosis and treatment. It is often difficult to differentiate between bacterial and non-bacterial meningitis. This study was done to evaluate serum PCT as a marker to differentiate bacterial and non-bacterial meningitis in children and assess its efficacy. Bacterial meningitis is a paediatric emergency with high mortality and morbidity. It must be diagnosed and treated promptly. Clinical criteria, gram staining, and bacterial antigen testing of CSF as well as the classic biological markers in blood (CRP, WBC, and neutrophil count) or CSF (protein level, glucose level, WBC, and neutrophil count) used alone do not offer 100% sensitivity and specificity for distinguishing bacterial and non-bacterial meningitis [2, 4]. Two or more days of waiting is required to identify bacterial growth in CSF cultures [4, 5]
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