Early Diagnosis Of Bacterial Meningitis Research Articles

Investigating Procalcitonin and C-Reactive Protein as Diagnostic Biomarkers in Pediatric Suspected Meningitis: A Forward-Looking Observational Analysis

Our study is a prospective observational study done on all suspected cases of meningitis admitted to Tertiary Care Hospital, India to study suspected meningitis cases and assess the predictive value of CRP and PCT in diagnosing meningitis. Indian studies are scarce in this regard. We included all clinically suspected cases of paediatric meningitis in our study.Basic investigations, including blood culture and sensitivity, CRP, and PCT, were sentsoon after admission, and CSF analysis and cultures were done once the child became hemodynamically stable. Based on CSF analysis and culture with a clinical profile, meningitis was diagnosed and classified as bacterial and viral meningitis. In this study,we also compared PCT and CRP in their capacity to predict meningitis and to distinguish between bacterial or viral meningitis. A majority of studies have shown that PCT levels can be used in the early diagnosis of bacterial meningitis. In our study, we found that there is no role for PCT in predicting meningitis. CRP has a positive correlation in predicting meningitis but it is elevated in infectious as well as inflammatory conditions. A simple routine complete CSF analysis is an effective, reliable and feasible way to diagnose meningitis in children. This study reiterates the fact that it is indeed the gold standard diagnostic test as no other single parameter can differentiate or diagnose meningitis.

Cerebrospinal Fluid Procalcitonin-A Potential Biomarker for Post-Craniotomy Bacterial Meningitis.

The literature regarding the utility of cerebrospinal fluid (CSF) procalcitonin (PCT) in the diagnosis of post-craniotomy bacterial meningitis and differentiating it from aseptic meningitis is sparse. CSF total WBC count, sugar, protein, and PCT were measured in febrile patients with suspected post-craniotomy meningitis during the first 30 days following an intradural cranial procedure for non-trauma indications. Patients were diagnosed as postoperative bacterial meningitis if CSF culture was positive (PBM, n = 28) or postoperative aseptic meningitis if CSF culture was sterile and there was no evidence of systemic infection (PAM, n = 31). CSF cytochemical parameters and PCT values were compared between the groups. Normal values of CSF PCT were obtained from 14 patients with noninfectious indications with hydrocephalus. There was no significant difference in CSF total WBC count, sugar, and protein levels between PAM and PBM groups. The median PCT level in CSF in the normal group was 0.03 ng/mL (interquartile range [IQR] 0.02-0.07 ng/mL). CSF PCT in the PBM group (median 0.37 ng/mL, IQR 0.2-1.4 ng/mL) was significantly higher than normal values as well as PAM group (median 0.12 ng/mL, IQR 0.07-0.26 ng/mL (P = 0.0004). The area under the receiver operating characteristic (ROC) curve for CSF PCT was 0.767. A cutoff value of 0.12 ng/mL yielded a sensitivity of 85.7% (95% CI: 67.3% to 96%), specificity of 51.6% (95% CI: 33% to 69.9%), positive predictive value of 61.5% (95% CI: 51.9% to 70.3%), and negative predictive value of 80% (95% CI: 60.3.8% to 91.3%). CSF PCT assay in patients who are febrile during the first 30 days post-non-trauma neurosurgical procedures has a role in the early diagnosis of bacterial meningitis.

Clinical and Laboratory Findings in Early Diagnosis of Bacterial Meningitis

Clinical and Laboratory Findings in Early Diagnosis of Bacterial Meningitis

Serum procalcitonin in bacterial & non-bacterial meningitis in children

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.

The value of serum procalcitonin in acute meningitis in children

Early diagnosis and initial therapy are important to reduce the complications of bacterial meningitis. We aimed to evaluate the diagnostic value of serum procalcitonin in children with acute meningitis. We included 40 children (4 months–14 years) suspected to have acute meningitis in our study. Based on the clinical scenario, physical examination and complete analysis of cerebrospinal fluid, patients were assigned into two groups: bacterial meningitis group (24 patients) and aseptic meningitis group (16 patients). Twenty-five apparently healthy children of matched age and sex served as a control group. Procalcitonin, C-reactive protein, and leukocyte count were measured initially at the time of admission and again after 72 h. Initially, patients with bacterial meningitis showed statistically significant higher values of serum procalcitonin than both patients with aseptic meningitis and the control groups (p < 0.001). After 72 h of treatment, patients of bacterial meningitis group showed statistically significant lower values of serum procalcitonin than their initial values (P < 0.05). The cutoff point of procalcitonin needed for early diagnosis of bacterial meningitis was >10 ng/ml at the time of admission. However, values of procalcitonin >2 ng/ml had 100% sensitivity. Whereas, the specificity, negative predictive value and positive predictive value of procalcitonin were 63%, 100%, and 67% respectively. Serum Procalcitonin can be used as an early diagnostic marker of acute bacterial meningitis and its differentiation from aseptic meningitis. In acute bacterial meningitis, it can be used to follow the response to antibiotic therapy.

Diagnostic Value of CRP, Procalcitonin, and Ferritin Levels in Cerebrospinal Fluid of Children with Meningitis.

Bacterial meningitis is a serious disease with high rate of mortality and morbidity in children. Invasion of pathogens causes brain and meningeal inflammation, which leads to the release of biomarkers into cerebrospinal fluid (CSF). Identification of these biomarkers can help the physicians to differentiate between bacterial and aseptic meningitis. In the current study, some of these biomarkers such as Procalcitonin, C reactive protein (CRP), and Ferritin, were compared in cerebrospinal fluid (CSF) of patients with bacterial and aseptic meningitis. In a prospective cross sectional study in a referral children hospital in Tehran during 2011- 2013, the CSF levels of Procalcitonin, Ferritin, and CRP were measured in 57 children with clinically suspected meningitis. The Mann-Whitney u test and the chi-square test were used to compare two groups, children with bacterial and aseptic meningitis. The cut-offs of biomarker levels for differentiation between the 2 groups were constructed by receiver-operating - characteristic curve (ROC). 57 subjects (30 bacterial and 27 aseptic meningitis), were enrolled in this survey. In comparing the two groups, the CSF levels of Ferritin, CRP, and procalcitonin in bacterial meningitis were significantly higher than in aseptic meningitis (P values=˂0.001, 0.001, ˂0.001respectively), with sensitivity/ specificity being 92.9% / 68%, 92.9% / 84%, and 96.4% / 80%, respectively. Positive Predictive Values (PPV) were, correspondingly, 96.4%, 92.8%, and 92.8% for procalcitonin, Ferritin, and CRP. Corresponding Negative Predictive Values (NPV) were, respectively equal to 95.4%, 70%, and 88%. CSF of children with bacterial meningitis contains higher levels of inflammatory mediators including Procalcitonin, Ferritin, and CRP, compared to aseptic meningitis The biomarkers provided high sensitivity (especially PCT) and specificity (especially CRP). Using these complementary biomarkers would be useful for early diagnosis of bacterial meningitis and selection of appropriate treatment.

Applicability and accuracy of Bacterial Meningitis Score in a resource-limited hospital setting in Thailand

Abstract Several studies have determined that Bacterial Meningitis Score (BMS) has a high sensitivity and specificity for distinguishing bacterial meningitis from aseptic meningitis. Thus, the authors conducted a cross-sectional study in 252 children with clinical suspected meningitis in the Hatyai Hospital located in the Southern part of Thailand. In this study, BMS has 100% sensitivity (95%CI; 0.799–1) and 62.1% specificity (95%CI; 0.554–0.682). Positive predictive value (PPV) was 18.5% (95%CI; 0.119–0.273) and negative predictive value (NPV) was 100% (95%CI; 0.967–1). BMS is a useful screening tool for early diagnosis of bacterial meningitis before cerebrospinal fluid culture result is known, especially when latex agglutination is not available. BMS is not recommended as a diagnostic confirmation tool because of its low specificity.

Role of cerebrospinal fluid IL-8 as a marker for differentiation between acute bacterial and aseptic meningitis.

No doubt, the distinguishing between bacterial and aseptic meningitis in the emergency department could help to limit unnecessary antibiotic use and hospital admissions. This study evaluated the role of cerebrospinal fluid IL-8 in differentiating acute bacterial meningitis (ABM) from aseptic meningitis (AM). A total of 80 hospitalized patients with clinical presentations of suspected acute meningitis were subjected to estimation of IL-8 CSF concentrations. The results showed that CSF IL-8 levels were higher in acute bacterial meningitis than in aseptic ones (p < 0.05). The best cut-off value of CSF IL8 for early diagnosis of bacterial meningitis was 3.6 ng/ml with a sensitivity of 82.5% and a specificity of 85.0%.

Cerebrospinal fluid ferritin in children with viral and bacterial meningitis

Despite the fact that the prognosis of bacterial meningitis has been improved by the influence of antibiotics, this disease is still one of the significant causes of morbidity and mortality in children. Rapid differentiation between bacterial and aseptic meningitis, and the need for immediate antibiotic treatment in the former, is crucial in the prognosis of these patients. Ferritin is one of the most sensitive biochemical markers investigated in cerebrospinal fluid (CSF) for the early diagnosis of bacterial meningitis. The present study aims to evaluate the diagnostic capability of CSF ferritin in differentiating bacterial and viral meningitis in the paediatric setting. A cross-sectional study was carried out in the referral Children’s Medical Center Hospital, Tehran, during 2008 and 2009. According to the inclusion criteria, CSF samples from 42 patients with suspected meningitis were obtained and divided into two meningitis groups, bacterial (n=18) and viral (n=24). Ferritin and other routine determinants (i.e., leucocytes, protein and glucose) were compared between the two groups. Ferritin concentration in the bacterial meningitis group was 106.39±86.96 ng/dL, which was considerably higher than in the viral meningitis group (10.17±14.09, P<0.001). Mean CSF protein concentration and cell count were significantly higher in the bacterial meningitis group and showed a positive correlation with CSF ferritin. In conclusion, this study suggests that CSF ferritin concentration is an accurate test for the early differentiation of bacterial and aseptic meningitis; however, further investigation on a larger cohort of patients is required to confirm this finding.

Childhood bacterial meningitis and usefulness of C-reactive protein

Background: C-reactive protein raises rapidly in the first 24–48 hours of occurrence of bacterial meningitis and in large incremental increases thereafter. This prospective study was undertaken in a tertiary care hospital of Armed Forces to ascertain the usefulness of C-reactive protein in early diagnosis of bacterial meningitis. Methods: All children admitted during the period of study, with clinical suspicion of meningitis were clinically, biochemically, cytologically and bacteriologically investigated to clinch the diagnosis. Blood and CSF were also sent for C-reactive protein assay by latex agglutination test. CSF gram staining, culture and biochemical results were taken as gold standard. CSF and serum CRP were then evaluated against this gold standard. Statistical analysis was done by Epiinfo 6. Results: There were 63 cases of meningitis admitted in the hospital. By gold standard, there were 38 cases of bacterial, 21 cases of tubercular and 4 cases of viral meningitis. H. influenza was the predominant organism grown. CSF C-reactive protein was raised in 33 cases of bacterial and 2 cases of tubercular meningitis. Serum C-reactive protein was raised in 29 cases of bacterial, and eight cases of tubercular meningitis. These tests were negative in all cases of viral meningitis. The sensitivity and specificity of serum and CSF C-reactive protein was 96% and 100%. Conclusion: Quantitative and qualitative assay of C-reactive protein is a simple bedside test. It can be completed in 10 minutes and requires only 0.2 ml of blood. This will significantly reduce unnecessary antibiotics to children.

Serum procalcitonin and cerebrospinal fluid cytokines level in children with meningitis

AIMS: To determine the level of serum procalcitonin and cerebrospinal fluid cytokines in children with bacterial or viral meningitis and to document the use of these parameters in differential diagnosis. RESULTS: Before the start of antibiotic treatment, serum procalcitonin and tumor necrosis factor alpha levels were found to be higher in acute bacterial meningitis compared with viral meningitis and with the control group. Similarly, cerebrospinal fluid interleukin-6 levels were found to be significantly higher in children with acute bacterial meningitis compared with viral meningitis. However, no significant difference was determined between groups in respect to the cerebrospinal fluid interleukin-8 level. CONCLUSION: Serum procalcitonin and cerebrospinal fluid tumor necrosis factor alpha levels can be used in the early diagnosis of bacterial meningitis. Similarly, they may be useful adjuncts in differential diagnosis of bacterial and viral meningitis.

Diagnostic capability of CSF ferritin in children with meningitis

The current study was performed to determine the normal cerebrospinal fluid (CSF) ferritin level according to age and cut-off value for early diagnosis of bacterial menignitis. The subjects (N = 203) consisted of children who received the CSF examination at Department of Pediatrics in Chonnam National University Hospital between May 1996 and July 2001. The subjects were classified into four groups; non-meningitis, viral meningitis, bacterial meningitis, and bacterial meningitis suspected group. CSF ferritin of the meningitis group was significantly higher than that of the non-meningitis or viral meningitis groups. CSF ferritin had positive correlation with white blood cell (WBC) count and protein in CSF but negative correlation with CSF glucose ( P < 0.01). CSF ferritin decreased progressively up to 1 year but such a tendency was not evident in patients over 1 year in age in the non-meningitis group. For early diagnosis of bacterial meningitis, 15.6 ng/mL was considered as the appropriate cut-off value of CSF ferritin (a sensitivity of 96.2% and a specificity of 96.6%).

CONVULSIONS WITH FEVER AS A PRESENTING FEATURE OF BACTERIAL MENINGITIS AMONG PRESCHOOL CHILDREN IN DEVELOPING COUNTRIES

The authors report 522 infants and young children aged between one month and six years who presented with convulsions and fever as emergencies in Nigeria. 22 had bacterial meningitis, six of whom lacked the usual signs of meningitis. Although features of complex febrile convulsions were significantly associated with bacterial meningitis, it is concluded that, as an aid to the early diagnosis of bacterial meningitis, all preschool children convulsing with fever in developing countries should have a lumbar puncture. This may reduce the contribution of meningitis to chronic neurological disabilities. The necessity for such a policy is illustrated by a case report of a young infant with convulsions and fever caused by meningitis, seen at a general hospital.

Increased cerebrospinal fluid lactate and early diagnosis of bacterial meningitis.

Increased cerebrospinal fluid lactate and early diagnosis of bacterial meningitis.