Serum procalcitonin in Egyptian patients with acute meningitis and a negative direct cerebrospinal fluid examination

To reduce the morbidity and mortality related to bacterial meningitis, it is important to discriminate bacterial meningitis from aseptic meningitis during the acute phase of the disease, when the clinical symptoms are often similar. To test the reliability of serum procalcitonin [PCT] to discriminate bacterial meningitis from aseptic meningitis in patients who have a negative direct cerebrospinal fluid [CSF] examination, and to evaluate the role of serum PCT to assess treatment efficacy compared with the total leukocyte count [TLC], erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]. Forty patients with suspected acute meningitis and negative gram stains were included, and ten healthy persons were included as controls. According to the clinical examination and the CSF cytochemical analysis and cultures, the patients were divided into bacterial and aseptic groups. The measurements of serum PCT, ESR, CRP and TLC were performed. Patients in the bacterial group had a higher value of serum PCT at admission and at 3 days post-treatment than those in the aseptic group, with a highly significant difference between them. Serum PCT and, to a lesser extent, TLC had prognostic value in patients with acute meningitis, and PCT is more useful because it can be frequently measured for the diagnosis and follow-up of bacterial meningitis.

C-reactive protien and lactate dehydrogenase in serum and cerebrospinal fluid in rapid and early diagnosis of childhood meningitis

Bacterial meningitis is still a life threatening epidemiological problem especially in many developing countries; considering its dire consequences, its prompt and accurate diagnosis has become a priority for clinicians. Because of the various limitations of conventionally used laboratory techniques, we evaluated and compared the diagnostic utility of C-reactive protein and lactate dehydrogenase in serum and cerebrospinal fluid in the diagnosis of bacterial meningitis and its effectivity in distinguishing it from aseptic meningitis. A total of 125 pediatric cases, aged between 1 month and 12 years, including patients with bacterial meningitis [n=45], aseptic meningitis [n=42] and a control group [n=38], were retrospectively analyzed on the basis of data from the initial clinical examinations. Cultures, smears and other common serum and CSF indices were compared with serum and CSF CRP levels and LDH activity. Compared with each of the other variables, there were significant differences in the mean values of serum-CRP, CSF-glucose, CSF-LDH and CSF/serum LDH ratio between the bacterial and aseptic meningitis groups [p<0.001]. Of all the tests applied, the highest sensitivity [95%] and negative predictive value [95%] belonged to CSF-LDH activity and the most specific [100%] test with the highest positive predictive value [100%] was CSF-CRP titration as well as smear and culture. Combination of CSF-CRP serum-CRP, and CSF-LDH yielded the highest sensitivity [100%] and negative predictive value but the combined application of CSF-LDH and CSF-CRP proved to be the most specific and efficient. In the presence of a normal CRP titration and low glucose level in CSF, bacterial meningitis is excluded, whereas elevated level of CSF-LDH activity is a valid confirmatory predictor of BM. In addition, combination of these three tests with serum CRP is far more effective than the separate determination of any of these parameters

Diagnostic utility of estimation of mycobacterial antigen A60 specific immunoglobulins in serum and CSF in adult neurotuberculosis.

An ELISA assay based on mycobacterial antigen A60 (Anda, Biologicals France) was used to detect specific immunoglobulins (IgM, IgA and IgG) in 48 cases of adult neurotuberculosis (24 TBM; 24 Tuberculoma) and in 48 controls (24 diseased controls; 24 healthy controls). Serum was analysed in all the subjects whereas CSF was assayed only in TBM cases and diseased controls. The cut off values used for IgM, IgG and IgA in this study were 1.500 ODI (optical density index) at 1:100 dil, 250 units/ml and 150units/ml respectively in serum; and 1.500 ODI at 1:10 dil, 10 units/ml and 10 units/ml respectively in CSF. The mean titres of all three antibodies were found to be significantly higher in cases as compared to controls. In cases of TBM, in serum, the percentage positivity for IgM, IgG, IgA and combination of IgG or IgA were 41.67, 87.50 87.50 and 95.83 respectively. The corresponding figures in CSF were 62.50, 75.0, 66.67 and 79.16 for IgM, IgG, IgA and 'IgA or IgM' respectively. In tuberculoma cases, in serum, the figures were 37.50, 75.0, 75.0 and 83.33 respectively. Overall, a high sensitivity and specificity were obtained in cases of TBM (Serum: ST = 95.83%: SP = 87.50%; CSF ST = 79.16%. SP = 100%) and Tuberculoma cases (serum: ST = 83.33% SP = 87.50%) employing the combined antibody estimations.

CSF/blood glucose ratio and other prognostic indices in pyogenic meningitis.

Fifty cases of pyogenic meningitis were examined for various prognostic indices, especially cerebrospinal fluid (CSF)/blood glucose ratio. Overall mortality was 40%. Age below one year and depressed level of consciousness were associated with high mortality. Illness of more than 7 days, presence of associated illness and absence of neck rigidity were not found to be statistically significant factors associated with higher mortality. CSF leucocyte count of more than 1000 cells/cmm and CSF protein more than 500 mg/dl were statistically significant factors associated with higher mortality. In cases of CSF glucose level below 20 mg/dl and CSF/blood glucose ratio below 0.2, the increase in mortality was highly significant. CSF/blood glucose ratio in cases who recovered was much higher than those who died. CSF/blood glucose ratio increased to normal in cases who recovered but remained low in cases who expired.

Cerebrospinal fluid N-acetyl neuraminic acid estimation for early diagnosis and differentiation of bacterial meningitis.

Cerebrospinal fluid (CSF) analysis for free, bound and total N-Acetyl Neuraminic Acid (NANA) as well as serum NANA was done in 68 patients of bacterial meningitis, of which 37 cases were of pyrogenic meningitis and 31 of tuberculous meningitis. Ten patients were included in the control group. The free NANA levels were increased in only pyogenic meningitis, independent of protein levels but the bound form increased with the increase in CSF proteins. The increase of free NANA in CSF of pyogenic meningitis patients was not related to the cell count or sugar content in CSF or to the duration or severity of illness. This finding can be of great help in differentiating cases of pyogenic meningitis, particularly partially treated patients, who may have ambiguous pictures of CSF analysis, from the cases of tuberculous meningitis.

Pyogenic meningitis.

Fifty cases with pyogenic meningitis, aged 15 to 72 years, with a male:female ratio of 5:1, were studied. The majority of cases (70%) were in the 15 to 25 years age group. The organisms detected in the 29 culture-positive cases included S aureus (12), pneumococci (9) and meningococci (8). Thirteen patients died; the poor prognostic factors included old age, the presence of coma or shock, CSF sugar below 10 mg/dl or protein above 750 mg/dl and the presence of gram negative organisms in the CSF.