Utility of Cerebrospinal Fluid Adenosine Deaminase and C-Reactive Protein in patients with Meningitis

Introduction: We aimed to assess the utility of cerebrospinal fluid (CSF) Adenosine deaminase (ADA) and C-reactive protein (CRP) in differentiating various types of meningitis in adult population. Materials and methods: The present observational study, conducted in the Department of Medicine, Lokmanya Tilak Municipal Medical College and Hospital from February 2016 till August 2017, included all meningitis and meningococcemia cases diagnosed according to the clinical and/or laboratory criteria during the study period were included in the study. Comparisons were made with respect to various biochemical investigations between patient groups diagnosed with various types of meningitis. Results: 38% were diagnosed as bacterial meningitis, 54% as tubercular meningitis and rest as viral meningitis. CSF ADA was significantly higher in tubercular meningitis as compared to bacterial or viral meningitis. Similarly, CSF CRP was found to be significantly higher among patients with bacterial meningitis. In tubercular meningitis, CSF ADA and CRP were not found to be significantly associated with CSF cell count, CSF protein or ratio of CSF/Blood glucose. In bacterial meningitis, CSF CRP was found to be significantly higher among patients with CSF protein between 101 to 200 mg/dl. Using a cut off value of 5 IU/L, CSF ADA was found to have a sensitivity of 100% and specificity of 91.3% in diagnosing tubercular meningitis and with cut off value of 9 mg/L, CSF CRP had a sensitivity of 97% and specificity of 100% in diagnosing bacterial meningitis. Conclusion: CSF ADA and CRP should be included in the workup of meningitis patients.

Clinico-epidemiological profile of meningitis patients diagnosed at a tertiary care hospital in Mumbai

Introduction: Meningitis is an inflammatory disease of the leptomeninges, the tissues surrounding the brain and spinal cord. Recently improved awareness, extensively available antibiotics and vaccines can change the epidemiological pattern of the disease. Materials and methods: The present observational study was conducted in the Department of Medicine, Lokmanya Tilak Municipal Medical College and Hospital from February 2016 till August 2017. The study population consisted of 100 patients admitted with features of acute meningitis. All meningitis and meningococcemia cases diagnosed according to the clinical and/or laboratory criteria during the study period were included in the study. Demographic and clinical data of the patients were recorded. Results: Of all the patients included in the study, 38% were diagnosed as bacterial meningitis, 54% as tubercular meningitis and rest as viral meningitis. All patients presented with symptoms of fever and neck stiffness. Headache, vomiting and altered sensorium were other common complaints. Most common CT head findings were that of a basal meningeal enhancement (89%). CSF was clear in 62% of the patients and raised erythrocyte count was observed in 74% of the patients. Mean adenosine deaminase (ADA) of the CSF in the study population was 7.93 ± 6.24 IU/L, ranging from 1 to 43 IU/L. Mean CSF C-reactive protein (CRP) in the study was 5.83 ± 7.11 mg/L, ranging from 0 to 25 mg/L. Conclusion: Understanding the current and future trends in meningitis are needed to improve the quality of patient care and outcomes.