Cerebrospinal Fluid C-reactive Protein Research Articles

C-reactive protein concentration has limited value in the diagnosis of meningoencephalitis of unknown origin in dogs.

To evaluate blood and cerebrospinal fluid (CSF) concentrations of C-reactive protein (CRP) in dogs with meningoencephalitis of unknown origin (MUO); to evaluate whether blood CRP concentration is associated with epidemiological, clinicopathologic, and MRI findings; and to investigate blood CRP predictive power in survival. 30 client-owned dogs with MUO, 15 client-owned dogs with steroid-responsive meningitis arteritis (SRMA; positive control group), and 15 healthy dogs (negative control group). Blood CRP concentration was measured in each group, while it was performed in CSF only in the MUO and SRMA groups. The analysis of epidemiological data included breed, age, sex, duration of clinical signs, and history of seizures. Blinded analysis of MRI was performed based on a classification grid, and traditional CSF analysis parameters were assessed. The predictive power of blood CRP concentration regarding survival at 6 months was investigated. Of the 30 dogs with MUO, 9 (30%) had an increased CRP concentration in blood, and 3 (10%) showed a measurable CRP in CSF. Median blood CRP concentration in dogs with MUO was 0.1 mg/L (range, 0.1 to 102 mg/L), which was not statistically different from the healthy dog group but significantly lower than the SRMA control group. Only the duration of clinical signs was positively associated with an increased blood CRP level. Blood CRP concentration was not associated with survival at 6 months. Blood CRP concentration is of limited value for the diagnosis and prognosis of dogs with MUO. Chronicity of the disease may be associated with an increased concentration of blood CRP.

Study of the Role of Cerebrospinal Fluid C-reactive Protein and Adenosine Deaminase to differentiate Various Types of Meningitis.

(1) To study cerebrospinal fluid (CSF) adenosine deaminase (ADA) and CSF C-reactive protein (CRP) levels in the differentiation of viral, pyogenic, and tuberculous meningitis (TBM). (2) To estimate the borderline levels of CRP in CSF in viral, pyogenic, and TBM. A prospective and cross-sectional study was conducted at the Department of Medicine, SRN Hospital, Prayagraj, Uttar Pradesh, India, between August 2016 and September 2018. In this study, a total of 100 patients with meningitis were included applying specific inclusion and exclusion criteria after proper ethical approval. Out of 100 patients, 61 were TBM, 31 were pyogenic meningitis, and eight were viral meningitis (VM). CSF CRP level was significantly increased in pyogenic meningitis (1.05 ± 0.36 mg/dL) compared to nonpyogenic meningitis [TBM (0.42 ± 0.13 mg/dL) and VM (0.37 ± 0.09 mg/dL)]. At the cut-off level of CRP in CSF > 0.6 mg/dL, its diagnostic sensitivity in pyogenic meningitis was 93.55% and specificity 94.20%. While CSF ADA levels were higher in the TBM group (13.32 ± 3.21 U/L) compared to the other two groups [pyogenic meningitis (6.15 ± 1.27 U/L) and VM (4.86 ± 0.88 U/L)]. At a cut-off, CSF ADA level of >10 U/L, its diagnostic sensitivity for TBM was 91.67% and specificity 90%. Cerebrospinal fluid (CSF) CRP levels were found to be raised in pyogenic meningitis, and CSF ADA was found to be elevated in TBM. While both ADA level and CRP level in CSF are found low in VM.

A study of cerebrospinal fluid C-reactive protein in bacterial meningitis among paediatric age group in a tertiary care hospital

Background: Bacterial meningitis is a significant cause of mortality and morbidity in children worldwide. C-reactive protein (CRP) raises rapidly in the first 24-48 hours of occurrence of bacterial meningitis and in large incremental increases thereafter. The present study was undertaken to find out the correlation between cerebrospinal fluid (CSF)-CRP and bacterial meningitis in paediatric age group. Methods: A total 123 children aged between 1 month to 12 years, in whom meningitis was suspected during the study period were included. Lumbar puncture performed at L3-L4 and CSF sample not more than 3 ml collected in 4 sterile containers. 1ml sent for protein and sugar, 0.5ml each sent for CSF cytology and CSF-CRP, 1ml sent for CSF culture sensitivity and gram staining. Results: The institutional incidence of bacterial meningitis was 3.37%. Fever (93.26%) and altered sensorium (92.30%), were the commonest symptoms and neck rigidity (58.65%) was the commonest meningeal sign. The neurologic assessment showed abnormal mental status (34.61%), abnormal cranial nerve findings (10.57%) and abnormal motor function (13.46%). The mean CRP level was 15.36±0.67 mg/l. Pneumococcus was the commonest isolated organism (53.48%) in CSF culture. The institutional mortality was 13.46%. CSF-CRP was positive in 104 (82.69%) of the culture-positive cases with a sensitivity of 82.69%, specificity 84.21%, positive predictive value 96.62% and negative predictive value of 47.05%. Conclusions: CRP levels in CSF offers a moderate sensitivity and specificity as well as high positive predictive value. This indicates that CSF-CRP is a better marker in differentiating bacterial meningitis and it can serve as a useful screening test for bacterial meningitis.

Comparison between cerebrospinal fluid biomarkers for differential diagnosis of acute meningitis.

Given the difficulty in the differential diagnosis of acute bacterial meningitis (BM) and viral meningitis (VM), we aimed to compare the ability of cerebrospinal fluid (CSF) biomarkers, such as lactate, glucose, lactate dehydrogenase (LDH), C-reactive protein (CRP), total white blood cell count, and predominance of neutrophils, as single tests to differentiate microbiologically defined acute BM and VM. CSF samples were divided into three groups: BM (n=17), VM (n=14) (both with the etiological agent identified), and normal control groups (n=26). All the biomarkers studied were significantly higher in the BM group than in the VM or control groups (p>0.05). CSF lactate showed the best diagnostic clinical performance characteristics: sensitivity (94.12%), specificity (100%), positive and negative predictive value (100 and 97.56%, respectively), positive and negative likelihood ratio (38.59 and 0.06, respectively), accuracy (98.25%), and AUC (0.97). CSF CRP is excellent for screening BM and VM, as its best feature is its specificity (100%). CSF LDH is not recommended for screening or case-finding. LDH levels were higher in Gram-negative diplococcus than in Gram-positive diplococcus. Other biomarkers were not different between Gram-positive and negative bacteria. The highest level of agreement between the CSF biomarkers was between CSF lactate and CRP [kappa coefficient, 0.91 (0.79; 1.00)]. All markers showed significant differences between the studied groups and were increased in acute BM. CSF lactate is better than the other biomarkers studied for screening acute BM due to its high specificity.

Identifying the Importance of Cerebrospinal Fluid C - reactive protein (CSF-CRP) in Establishing a Diagnosis of Acute Bacterial Meningitis

Introduction: Acute meningitis is a major cause of death and disability worldwide. Differentiating bacterial from nonbacterial meningitis is very important in deciding on treatment. Bacterial meningitis is a life-threatening neurological condition and needs prompt parenteral antibiotics, compared to viral and aseptic meningitis which carries relatively better outcomes. Aim of the study: The aim of the study was to identify the importance of the CSF-CRP test in diagnosing acute bacterial meningitis. Methods: This cross-sectional observational study was conducted at the Department of Pediatric Medicine, Dhaka Shishu Hospital, Dhaka, Bangladesh. The study duration was 6 months, from January 2017 to June 2017. A total of 100 children visiting the inpatient department of the hospital were selected for the present study following inclusion and exclusion criteria. Result: 57% were diagnosed as bacterial meningitis cases, while 43% were diagnosed with aseptic meningitis. Among the 57 cases of bacterial meningitis, 61.40% belonged to the youngest age group of 0-2 years, while among the aseptic meningitis cases, 37.21% belonged to the age group of 3-6 years. Total WBC and PBN were significantly higher among the bacterial meningitis cases. The sensitivity of CSF-CRP was 89.47%, specificity 90.69%, accuracy 90%, a positive predictive value of 92.72%, and a negative predictive value of 86.66% in diagnosing bacterial meningitis. Conclusion: The study findings conclude CSF-CRP to be an important prognostic factor and initial testing method in diagnosing acute bacterial meningitis. CSF CRP has high diagnostic accuracy in determining the incidence of acute bacterial meningitis.

Study of CSF C-Reactive Protein for the Differentiation of Bacterial Meningitis from Aseptic Meningitis in Children

Background: Acute meningitis is a major cause of death, and disability worldwide. Differentiating bacterial from nonbacterial meningitis is very important in deciding on treatment. Bacterial meningitis is a life-threatening neurological condition, and needs prompt parenteral antibiotics, compared to viral, and aseptic meningitis which carries relatively better outcomes. Objective: To identify the importance of Cerebrospinal fluid C- reactive protein (CSF-CRP) to establish the diagnosis of ABM. Method: This study was conducted from 01 January 2017 to 30th June 2017 at the indoor department of Pediatric Medicine at Bangladesh Sishu Hospital & Institute (BSH & I) to the measure of CSF C-Reactive protein for the differentiation of bacterial meningitis from aseptic meningitis in children. One hundred patients had participated after meeting the inclusion, and exclusion criteria. Patients were selected by purposive sampling. Ethical clearance was obtained from the National Health Research Ethics Committee, BangladeshShishu Hospital& Institute, Dhaka. Results: Out of 57 cases of bacterial meningitis, 22 cases were culture-negative, and 35 cases were culture-positive. 22 cases (62.85%) out of 35 cases culture positive were Streptococcus Pneumoniae followed by 08 cases (22.85%) were Neisseria Meningitis, Haemophilus Influenza 3 cases (8.57%), E.coli were 02 cases (5.71%). WBC count & PMN (%) were increased significantly in bacterial meningitis, compared to aseptic meningitis. Protein and glucose levels in CSF were not significantly different between bacterial meningitis, and the aseptic meningitis group (Table 2). In the case of bacterial meningitis, in 51(89.47%) cases out of 57, the CSF CRP test was truly positive, mean±SD 21.7±10.9, and false negative were only 6 cases (10.52%). In aseptic meningitis 39 cases (90.69%) out of 43 cases, the CSF-CRP test was truly negative, and false positives were 04 cases (9.30%). (Table-4) shows outcome in the meningitis group showed .....

“Study of Estimation of Cerebrospinal Fluid C-Reactive Protein in Diagnosis of Acute Meningitis.”

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.

Tocilizumab is safe and tolerable and reduces C-reactive protein concentrations in the plasma and cerebrospinal fluid of ALS patients.

We tested safety, tolerability, and target engagement of tocilizumab in amyotrophic lateral sclerosis (ALS) patients. Twenty-two participants, whose peripheral blood mononuclear cell (PBMC) gene expression profile reflected high messenger ribonucleic acid (mRNA) expression of inflammatory markers, were randomized 2:1 to three tocilizumab or placebo treatments (weeks 0, 4, and 8; 8mg/kg intravenous). Participants were followed every 4wk in a double-blind fashion for 16 wk and assessed for safety, tolerability, plasma inflammatory markers, and clinical measures. Cerebrospinal fluid (CSF) was collected at baseline and after the third treatment. Participants were genotyped for Asp358 Ala polymorphism of the interleukin 6 receptor (IL-6R) gene. Baseline characteristics, safety, and tolerability were similar between treatment groups. One serious adverse event was reported in the placebo group; no deaths occurred. Mean plasma C-reactive protein (CRP) level decreased by 88% in the tocilizumab group and increased by 4% in the placebo group (-3.0-fold relative change, P < .001). CSF CRP reduction (-1.8-fold relative change, P=.01) was associated with IL-6R C allele count. No differences in PBMC gene expression or clinical measures were observed between groups. Tocilizumab treatment was safe and well tolerated. PBMC gene expression profile was inadequate as a predictive or pharmacodynamic biomarker. Treatment reduced CRP levels in plasma and CSF, with CSF effects potentially dependent on IL-6R Asp358 Ala genotype. IL-6 trans-signaling may mediate a distinct central nervous system response in individuals inheriting the IL-6R C allele. These results warrant further study in ALS patients where IL-6R genotype and CRP levels may be useful enrichment biomarkers.

Cerebrospinal Fluid and Serum C-Reactive Protein among Children with Acute Encephalitis Syndrome

Abstract Objectives This study aimed to evaluate the positivity of C-reactive protein (CRP) in cerebrospinal fluid (CSF) and serum in children presented with clinical diagnosis of acute encephalitis syndrome (AES). Methods A total of 164 children between 6 months and 14 years with clinical diagnosis of AES were investigated. Qualitative CRP (slide agglutination) was determined in CSF and serum sample of each patient. On the basis of clinical examination and investigations, all the patients were divided into four groups as pyogenic meningitis, viral encephalitis, tuberculous meningitis, and cerebral malaria. The positivity of CRP in CSF and serum were compared in these groups. Results CSF CRP was found to be positive in the majority of patients with pyogenic meningitis and a statistically significant (p ≤ 0.001) association was found between CSF CRP and final diagnosis of AES, while this association was nonsignificant (p = 0.141) in case of serum CRP. When we compared the CSF and serum CRP, serum CRP was found to be more suggestive of tuberculous meningitis, viral encephalitis, and cerebral malaria while CSF CRP was more sensitive and specific for the diagnosis of pyogenic meningitis. Conclusion The sensitivity and specificity of CSF CRP for pyogenic meningitis was quite high. Serum CRP with a high sensitivity can be used as a screening test for different types of meningitis and cerebral malaria; however, its diagnostic accuracy has yet to be established.

Role of cerebrospinal fluid C-reactive protein in tuberculous meningitis.

Tuberculosis (TB) is still a significant health problem worldwide. Central nervous system TB amounts to 10% of all cases of TB. Despite advances in the pharmacological management of TB, the overall outcomes remain poor with significant mortality and morbidity. There are no predictors for neurological outcomes in tuberculosis meningitis (TBM). In this study, we aimed to evaluate the role of cerebrospinal fluid (CSF) C-reactive protein (CRP) in predicting mortality and neurological outcome in TBM. Method: In this observational study, all patients with TBM were recruited prospectively over a 12-month duration. Baseline demographic data, laboratory parameters, and Imaging findings were collected. CSF CRP was obtained on the CSF sample collected at the time of diagnosis. Patients were followed up at 3 months to assess neurological status and mortality. Seventy-one patients with TBM were recruited in this study. The overall mortality in this study was 22.5% of patients. The primary composite outcome of mortality and adverse neurological outcome occurred in 40.8%. The CSF CRP levels ranged between 0.1 and 4.8 mg/dl, and the mean CSF CRP level was 1.11 mg/dl. The Relative risk for a patient with high CSF CRP to develop adverse outcome was 1.84 (P = 0.038). CSF CRP was a good predictor of mortality with a relative risk of 2.92 (P = 0.027). Stroke in TBM had a high incidence of 47.9% and a relative risk of 3.42 for an adverse neurological outcome. CSF CRP did not predict the occurrence of stroke. Hydrocephalus and elevated intracranial pressure were good predictors of stroke. TBM is a disease with significant mortality and morbidity. CRP level in the CSF can be measured, but a highly sensitive scale may be needed as the mean values were much lower compared to the serum values. CSF CRP Levels showed significant associations with adverse outcomes and mortality.

Role of CSF-CRP as a Diagnostic Marker in Neonatal Meningitis

Background: Cerebrospinal fluid C-reactive protein (CSF-CRP) in adults and children has been shown to be useful for the diagnosis of bacterial meningitis; however, it has not been evaluated in neonates. Objective: To study the role of CSF-CRP as a diagnostic marker in neonatal meningitis and determine optimal cut-offs for diagnosis. Study Design: Prospective observational study from June 2017 to December 2017. Methodology: Routine CSF analysis along with CSF-CRP was performed in neonates who qualified for lumbar puncture. Results: At a cut-off value of 3.8 mg/L, CSF-CRP had a sensitivity of 0.96 and a specificity of 0.44, with positive and negative predictive values of 0.63 and 0.91, respectively. Conclusion: CSF-CRP has higher diagnostic efficiency than other CSF markers. At a value of 3.8 mg/L, it has a high sensitivity and a negative predictive value to rule out meningitis.

Utility of C-reactive protein and serum amyloid A in the diagnosis of equine protozoal myeloencephalitis.

BackgroundAccurate antemortem EPM diagnosis requires evidence of intrathecal antibody production. Some advocate the use of acute phase proteins in addition to serology, which alone results in substantial false positives.Hypothesis/ObjectivesThe purpose of this study was to determine if serum C‐reactive protein (CRP) or serum amyloid A (SAA) concentrations were elevated in cases of equine protozoal myeloencephalitis (EPM) compared to other neurological diseases.Animals25 clinical cases of equine neurological disease: EPM (10), cervical vertebral stenotic myelopathy (CVSM) (10), neuroborreliosis (2), equine motor neuron disease (1), degenerative myelopathy (1), and leukoencephalomalacia (1).MethodsSerum and CSF CRP and SAA were measured. Selection criteria included neurologic disease, antemortem diagnosis of EPM or CVSM, or postmortem diagnosis of EPM, CVSM, or other neurologic disease, and availability of serological results and archived samples for testing.ResultsSerum SAA and serum CRP levels were generally undetectable or low in horses with EPM (median CRP ≤0.1 mg/L, ≤0.1‐14.4 mg/L; median SAA ≤0.1 mg/L, ≤0.1‐6.11 mg/L) and CVSM (median CRP ≤0.1, ≤0.1‐2.41 mg/L; median SAA ≤0.1mg/L, ≤0.1‐13.88 mg/L). CSF CRP and SAA for horses with EPM (median CRP 3.35 mg/l, 0.19‐13.43 mg/l; median SAA ≤0.1 mg/L, ≤0.1‐2.4 mg/L) and CVSM (median CRP 4.015 mg/L, 0.16‐9.62 mg/L; median SAA 0.62 mg/L, ≤0.1‐2.91 mg/L) were also undetectable or low. Kruskal–Wallis test showed no statistically significant differences between serum CRP (P = .14), serum SAA (P = .79), spinal fluid CRP (P = .65), or spinal fluid SAA between horses with EPM and CVSM (P = .52).ConclusionNeither SAA nor CRP in serum or CSF aid diagnosis of EPM.

Evaluation of Cerebrospinal Fluid C-Reactive Protein for Differentiating Pyogenic Meningitis from non Pyogenic Meningitis

Evaluation of Cerebrospinal Fluid C-Reactive Protein for Differentiating Pyogenic Meningitis from non Pyogenic Meningitis

Cerebrospinal Fluid C-Reactive Protein in Parkinson's Disease: Associations with Motor and Non-motor Symptoms.

Parkinson' disease (PD) is characterized by motor symptoms including bradykinesia, resting tremor, postural instability, and rigidity and non-motor symptoms such as cognitive impairment, sleep disorder, and depression. Neuroinflammation has been recently implicated in pathophysiology of both motor and non-motor symptoms of PD. One of the most notable inflammatory proteins is C-reactive protein (CRP), which is elevated in the conditions of systemic inflammation. Using BioFIND database, we scrutinized the possible association between cerebrospinal fluid (CSF) levels of CRP and severity of PD motor and non-motor symptoms. Eighty-four healthy controls (HCs) and 109 PD subjects were entered into this study. A significant correlation was observed between CSF CRP levels and Movement Disorder Society-Unified Parkinson's Disease Rating Scale PartIII (MDS-UPDRS part III) score and Montreal Cognitive Assessment (MoCA) score in PD patients. We found significant correlations between MoCA score and CSF CRP levels in female patients and between CSF CRP and MDS-UPDRS part III score and MoCA score in male patients. In linear regression, CSF CRP could predict 6.9 and 10% of changes in MDS-UPDRS part III score in all PD patients male PD patients, respectively. In summary, we confirmed that CSF concentrations of CRP are in correlation with motor and non-motor severity in PD subjects. Our findings suggest that neuroinflammation plays an important role in the initiation and probably progression of PD motor and non-motor symptoms, which may give us a better insight into the underlying pathologic mechanisms in PD.

What does plasma CRP tell us about peripheral and central inflammation in depression?

Peripheral blood C-reactive protein (CRP) is a biomarker used clinically to measure systemic inflammation and is reproducibly increased in a subset of patients with major depressive disorder (MDD). Furthermore, increased peripheral blood CRP in MDD has been associated with altered reward circuitry and increased brain glutamate in relation with symptoms of anhedonia. Nevertheless, the relationship between peripheral CRP and other peripheral and central markers of inflammation in depressed patients has not been established. Plasma (n=89) and CSF (n=73) was collected from medically-stable, currently-unmedicated adult outpatients with MDD. Associations among plasma and CSF CRP and plasma and CSF inflammatory cytokines (interleukin [IL]-6, tumor necrosis factor [TNF] and IL-1beta) and their soluble receptors/antagonists were examined. Relationships between plasma and CSF inflammatory markers and depressive symptoms including anhedonia and reduced motivation (RM) were also explored. Plasma CRP was correlated with multiple plasma inflammatory markers (all p<0.05), and a strong correlation was found between plasma and CSF CRP (r=0.855, p<0.001). CSF CRP in turn correlated with CSF cytokine receptors/antagonists (all p<0.05). Principal component analyses revealed clusters of CSF inflammatory markers that were associated with high plasma CRP (>3mg/L) and correlated with depressive symptom severity. These findings were driven by CSF TNF, which correlated with RM (r=0.236, p=0.045), and CSF IL-6 soluble receptor, which correlated with anhedonia (r=0.301, p=0.010) in the sample as a whole and particularly females. CRP appears to be a peripheral biomarker that reflects peripheral and central inflammation and seems well-suited for guiding immunotherapies targeting TNF and IL-6 in patients with MDD.

Clinical significance of changes in IL-6, CRP and S100in serum and NO in cerebrospinal fluid insubarachnoid hemorrhage and prognosis.

Clinical significance of changes in interleukin-6 (IL-6), C-reactive protein (CRP) and S100 in serum and NO was investigated in cerebrospinal fluid (CSF) in subarachnoid hemorrhage (SAH) and its prognosis. A total of 43 SAH patients and 23 healthy subjects were selected and divided into cerebral vasospasm (CVS) group and non-CVS group, and favorable prognosis group and unfavorable prognosis group according to Hunt-Hess grade. The levels of IL-6, CRP, S100 and NO in CSF were detected, respectively, followed by statistical analysis of correlation. The higher the Hunt grade was, the higher the factor expression was; the expression levels of IL-6, CRP, S100 and NO in CSF were gradually increased in CVS group and unfavorable prognosis group, and the differences were significant compared with those in the control group. There was a positive correlation between the expression levels of each of the two factors among IL-6, CRP, S100 and NO in CSF, and the differences were statistically significant (P<0.05). The expression levels of IL-6, CRP, S100 and NO in CSF in SAH patients are significantly increased, showing positive correlations and participating in the occurrence and development of SAH, which provide new directions for the early clinical diagnosis of SAH.

Cerebrospinal fluid C-reactive protein - A point of care test in the diagnosis of bacterial meningitis

Background: Bacterial meningitis is a significant life-threatening illness during infancy and childhood. Delay in distinguishing bacterial from viral or other aseptic meningoencephalitis may have irrevocable consequences. A typical case of pyogenic meningitis without prior antibiotics may not create any diagnostic problems, but prior treatment with inappropriate and inadequate antibiotics may cause sufficient alteration in biochemistry and cytology of cerebrospinal fluid (CSF), and organisms may not get isolated from blood or CSF culture. Objective: C-reactive protein in CSF (CSF-CRP) has been reported to be one of the most reliable and early indices to differentiate bacterial from non-bacterial meningitis. This study was undertaken to evaluate the diagnostic significance of CSF- CRP as an early indicator in the differentiation of bacterial from non-bacterial meningitis. Materials and Methods: This descriptive study was done in children in the age group of 1 month to 12 years who were admitted with history and clinical features suggestive of acute central nervous system infection. CSF was analyzed for macroscopic appearance, pleocytosis, proteins, and sugar content, Grams and Ziehl

Role of CSF C-Reactive Protein for Rapid Diagnosis and Differentiation of Different Forms of Meningitis in Children

Role of CSF C-Reactive Protein for Rapid Diagnosis and Differentiation of Different Forms of Meningitis in Children

Study of CSF C-reactive protein in meningitis to differentiate bacterial meningitis from aseptic meningitis in children between 1 month and 12 years of age

Background: Meningitis is a serious illness of childhood. CSF Gram stain and culture is the gold standard for diagnosis which is a costly and time consuming. So, this study was conducted with the objective to measure the specificity, sensitivity, positive and negative predictive values and diagnostic accuracy of CSF-CRP in the diagnosis of bacterial meningitis.Methods: This prospective study was conducted in Department of Pediatrics, National Institute of Medical Sciences and Research, Jaipur. Children between 1 month to 12 years of age admitted with acute history of fever and seizure were included. CSF was sent for CRP estimation and other laboratory investigations. CSF CRP was determined qualitatively and value &gt;6mcg/ml was considered positive. Patients were divided into three groups based on clinical and CSF findings. Group 1 (Bacterial meningitis), Group 2 (Aseptic Meningitis) and Group 3 (No meningitis/Control Group). Statistical analysis was done using software SPSS version 23.Results: 120 patients were enrolled in our study. 65% of our cases were males. The mean age of our cases was 74.9±39.8 months. 48 cases had bacterial meningitis, 42 cases had Aseptic Meningitis and 30 cases had no meningitis. CSF-CRP was positive in 35 cases of Bacterial meningitis, 6 cases of aseptic meningitis and negative in all cases of control group. Hence the Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Diagnostic Accuracy of CSF-CRP for diagnosis of bacterial meningitis were 72.92%, 85.71%, 85.71%, 73.47% and 78.89% respectively. CSF-CRP cases of bacterial meningitis were also found to have a poor outcome.Conclusions:CSF-CRP can be used as an initial test for the diagnosis of Bacterial Meningitis till other confirmatory test reports are awaited.

Diagnostic value of CSF C-reactive protein in meningitis: A prospective study

Objective: To establish diagnostic role of CSF C-reactive protein quantitatively in meningitis.Method: It is a prospective observational study conducted at tertiary care centre in south Rajasthan. Total 100 patients were included and allocated into three groups based on clinical signs & symptoms; group-I Bacterial meningitis (n=50), group-II Tubercular meningitis (n=30) and group-III Control group (n=20). Along with other appropriate investigations, quantitative CSF C-reactive protein (CRP) was assayed and data were analysed to set a diagnostic level and sensitivity & specificity of CSF C-reactive protein (CRP) in meningitisResult: In group-I patients CSF CRP value was 3.172.68 g/ml; in group-II CSF CRP value was 0.080.12 g/ml and in group-III CSF CRP value was 0.030.02 g/ml. The CSF CRP value in bacterial meningitis is significantly higher than tubercular meningitis and control (P value 0.1 g/ml has sensitivity 98.07%, specificity 96.00%, positive predictive value 96.22%, and negative predictive value 97.95%.Conclusion: CSF CRP can easily differentiate bacterial meningitis from other meningitis with greater sensitivity and specificity.