Abstract
Backgroundand study aim:The differential diagnosis between bacterial meningitis and aseptic meningitis is a critical clinical issue and searching for reliable and valid markers is required. This work aimed to assess the role of the combined measuring of CSF lactate and serum procalcitonin in the diagnosis of acute bacterial meningitis. Patients and Method:A cross-sectional study including 42 meningitis patients was conducted at Zagazig Fever Hospital and Zagazig University Hospitals in the period from November 2018 to June 2019, Patients were divided according to their final diagnosis into two groups; group I included 13 patients with bacterial meningitis ( positive CSF bacterial culture and/or Gram stain ), group II included 29 patients with aseptic meningitis (negative CSF bacterial culture and Gram stain), The data collection sheet included clinical assessments, lumbar puncture with CSF analysis, CSF lactate level testing, and Serum procalcitonin level testing. Results: One hundred five of house officer participated Serum procalcitonin and CSF lactate levels were significantly higher in the bacterial meningitis group (1.16 ±1.24, 7.5 ± 6.6, respectively) than patients with aseptic meningitis (0.059 ± 0.04, 3.98 ± 2.1, respectively). The measuring of both serum procalcitonin and CSF lactate levels had got a higher sensitivity, specificity, and accuracy (96.6%, 76.9%, 90.9% respectively) for the diagnosis of bacterial meningitis more than measuring either of them only. Conclusion: The combined measuring of both serum procalcitonin and CSF lactate levels is highly accurate in the diagnosis of bacterial meningitis cases and helps to differentiate bacterial meningitis from aseptic meningitis.
Highlights
Bacterial meningitis is an inflammation of the meninges due to bacterial infection and represents one of the endemic diseases in Egypt [1,2]
The isolated bacteria included Neisseria meningitidis in 7 cases, Streptococcus Pneumoniae in 3 cases, Haemophilus influenzae in 2 cases, Escherichia coli in one case
Serum PCT and CSF lactate levels were significantly higher in the bacterial meningitis group (1.16 ±1.24, 7.5 ± 6.6, respectively) than patients with aseptic meningitis (0.059 ± 0.04, 3.98 ± 2.1, respectively)
Summary
Bacterial meningitis is an inflammation of the meninges due to bacterial infection and represents one of the endemic diseases in Egypt [1,2]. Aseptic meningitis is an inflammation of meninges without evidence of bacterial infection on bacterial cultures and Gram staining. It is usually accompanied by a mononuclear pleocytosis [3].The commonest cause of bacterial meningitis is Neisseria meningitidis, Haemophilus influenzae type b, Streptococcus pneumoniae [4], while the common cause of aseptic meningitis is viral meningitis [5]. Positive CSF bacterial culture and Gram staining are considered the gold standard in the diagnosis of bacterial meningitis. They have poor sensitivity and the bacterial culture is timeconsuming [7]
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