ABSTRACT
Background: Procalcitonin in cerebrospinal fluid has been evaluated with regard to its usefulness in distinguishing between the possible causative organisms for infections. CSF PCT as a diagnostic marker has also been evaluated for differentiating bacterial from viral meningitis with conflicting results obtained so far. The current study was designed to see the role of procalcitonin as diagnostic marker and in differentiating bacterial from aseptic meningitis in pediatric age group.Methods: Children from 5 months to 15 years of age who were suspected cases of meningitis and were admitted to Pediatric Department in SKIMS Srinagar, Jammu and Kashmir were included in this case control prospective study conducted from 2014 to 2016. The total number of 200 children participated in the study among which 100 were cases and 100 controls. Serum and CSF PCT was measured by a fluorescence immunoassay using QDX Instacheck with a detection limit of 0.25-100 ng/ml. Data was analyzed by using standard statistical tests using SPSS 20.Results: The mean CSF PCT in ng/ml in our study for viral meningitis was 0.59'0.43 (range=0.00-1.90), for bacterial meningitis 4.92'1.50 (range=2.89-10.82) and for controls 0.22'0.11 (range=0.00-0.32), respectively. CSF PCT was significantly higher in viral and bacterial meningitis as compared to controls (p<0.01) and significantly higher in bacterial meningitis as compared to viral meningitis (p<0.01). An AUC of 1.000 was established using serum and CSF PCT for bacterial meningitis. The diagnostic accuracy of serum and CSF PCT was almost 100% at cut-off of 2.2 ng/ml and 2.89 ng/ml, respectively.Conclusions: Author have concluded that CSF PCT can be used as a diagnostic marker with better results in differentiation of bacterial from aseptic meningitis.
ABSTRACT
The differentiation of lymphoid cells is tightly regulated by transcription factors at various stages during their development. During the maturation processes, different genomic alterations or aberrations such as chromosomal translocation, mutation and deletions may occur that can eventually result in distinct biological and clinical tumors. The different differentiation stages create heterogeneity in lymphoid malignancies, which can complicate the diagnosis. The initial diagnostic scheme for lymphoid diseases was coined by Rappaport followed by Revised European and American Classification of Lymphoid Neoplasms (REAL) and World Health Organization (WHO) classifications. These classification methods were based on histological, immunophenotypic and cytogenetic markers and widely accepted by pathologists and oncologists worldwide. During last several decades, great progress has been made in understanding the etiology, pathogenesis and molecular biology of malignant lymphoma. However, detailed knowledge in the molecular mechanism of lymphomagenesis is largely unknown. New therapeutic protocols based on the new classification have been on clinical trials, but with little success. Therefore, it is imperative to understand the basic biology of the tumor at molecular level. One important approach will be to measure the activity of the tumor genome and this can partly be achieved by the measurement of whole cellular mRNA. One of the key technologies to perform a high-throughput analysis is DNA microarray technology. The genome-wide transcriptional measurement, also called gene expression profile (GEP) can accurately define the biological phenotype of the tumor. In this review, important discoveries made by genome-wide GEP in understanding the biology of lymphoma and additionally the diagnostic and prognostic value of microarrays are discussed.