Abstract
Objectives:To assess the diagnostic role of CSF C-reactive protein quantitatively in acute meningitisand to evaluate the efficacy of CSF C-reactive protein in differentiating pyogenic meningitis fromnon-pyogenic meningitis.Material and Methods: It is a prospective observational study of total 102children with suspected meningitis allocated into three groups based on initial investigations; group-I Pyogenic meningitis, group-II Non-Pyogenic meningitis and group-III No meningitis (Controlgroup). Quantitative CSF C-reactive protein was detected by the latex agglutination method. Datawere analyzed to establish the diagnostic role of CSF-CRP and to evaluate the efficacy of CSF-CRP indifferentiating pyogenic meningitis from non-pyogenic meningitis.Results: A total of 102 clinicallysuspected meningitis patients were studied. Based on CSF findings, the study population (102cases) was categorized into 3 groups. Group I was pyogenic meningitis consist 53 cases (51.96%).Group II was Non-Pyogenic meningitis consists 27 cases (26.47%). Group III was normal CSFfindings consist 22 (21.56%). 98.1% cases of pyogenic meningitis had elevated CSF-CRP level >1.1μg/ml of CSF. In the case of Non-Pyogenic meningitis, 96.2% were found to have CSF- CRP in therange of 0.05-0.10 μg/ml. The mean value of CSF-CRP in groups I,II and III were 5.57±1.48,0.09±0.042 and 0.01±0.010 respectively. Conclusion: Detection of CSF-CRP provides a newdimension to establish the diagnosis of pyogenic meningitis. It is a rapid, reliable and sensitivediagnostic test. From this study it is concluded that CSF-CRP can be used to differentiate pyogenicfrom non-pyogenic meningitis. Early, accurate and appropriate therapy can ameliorate the morbidityand mortality rates in such cases.
Highlights
Acute infections of the nervous system are among the most important and common conditions in pediatrics
The case-fatality rate can be as high as 70 percent, and one in five survivors of bacterial meningitis may be left with permanent sequelae including hearing loss, neurologic disability [2]
Among 102 cases, 53 (51.96%) were diagnosed as Pyogenic meningitis (Group I), 27 (26.47%) as NonPyogenic meningitis (Group II) and 22 (21.56%) as No meningitis (Group III, normal cerebrospinal fluid (CSF)).[Figure 1] Figure 1: Categories of the study population based on CSF findings
Summary
Acute infections of the nervous system are among the most important and common conditions in pediatrics. These distinct clinical syndromes include acute pyogenic meningitis, viral meningitisencephalitis, focal infections such as brain abscess and subdural empyema, and infectious thrombophlebitis. Recognition & diagnosis with the rapid institution of therapy can be lifesaving[1].Meningitis is a significant cause of morbidity and mortality in children worldwide. The case-fatality rate can be as high as 70 percent, and one in five survivors of bacterial meningitis may be left with permanent sequelae including hearing loss, neurologic disability [2]. Case fatality rates for bacterial meningitis range from 4.5% in developed countries to 15–50% in developing countries [3,4]. Quick diagnosis and effective management is key to success [5]
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