C reactive protein for differentiating bacterial from aseptic meningitis in Thai patients.

OBJECTIVES: To evaluate the efficacy of serum CRP level differentiating between bacterial and aseptic meningitis in Thai patients. MATERIAL AND METHOD: The authors measured the serum CRP level in patients who were diagnosed clinically as bacterial and aseptic meningitis. RESULTS: The authors evaluated 32 subjects, 12 with bacterial meningitis (all males) and 20 with aseptic meningitis (13 males, 7 females). The mean serum CRP level in the bacterial meningitis and aseptic meningitis group was 209.25 +/- 105.34 (range, 65 to 420) and 67.05 +/- 40.81 (range, 10 to 169) mg/L, respectively (p < 0.001). CONCLUSIONS: Serum CRP can help differentiate between bacterial and aseptic meningitis.

RT-nested PCR for the detection of enterovirus in biological samples from patients with suspected enteroviral infections

In this study, we have tested a reverse transcription (RT) nested polymerase chain reaction (nPCR) for detection of enterovirus (EV) RNA in cerebrospinal fluid (CSF), serum samples, and conjunctival swabs (CS) from patients with suspected enterovirus infections. A specific 113-bp fragment was amplified using primers designed based on 5' non coding region of the enterovirus genome. The enterovirus RT-nPCR was able to detect 0.001 plaque forming unit (pfu)/ml. Since no PCR product was detected in each of the CSF, CS and serum samples from patients with proven-non-enterovirus viral infections, this method was found to be specific. EV RNA was detected in all 30 culture-confirmed CSF samples and yielded positive results in 5 out of 7 additional cases of culture-negative CSF samples with other evidences of enterovirus infection. Overall, EV RNA was detected in 95 of the patients with clinical diagnosis of viral central nervous system (CNS) disease and confirmed enterovirus infection. Furthermore, we were able to detect EV RNA in 24 (47) out of 51 CSF samples from patients with clinical diagnosis of viral CNS disease and negative laboratory evidence of viral infection. The percentage of positive EV RNA detection in paired CSF and serum samples from 11 patients with an enterovirus isolate in CSF was 100 (11 of 11) and 73 (8 of 11), respectively. In addition, EV-specific IgM was detected in 64 (7 of 11) of the sera tested. The method was also tested against 136 samples of CS from patients with clinical diagnosis of acute hemorrhagic conjunctivitis. Ninety nine of them resulted positive (73), while only 27 (20) had been positive for viral culture. In summary, our study shows the importance of enterovirus RT-nPCR for the diagnosis of enterovirus associated disease in different kind of biological samples and different types of diseases.

Variáveis clínicas e laboratoriais para diagnóstico diferencial entre meningites asséptica e piogênica em crianças / Laboratorial and clinical variables to the differential diagnosis between aseptic and pyogenic meningitis in children

Foram estudadas informaçöes obtidas do prontuário de 573 crianças com idade entre 1 mês e 15 anos e diagnóstico de meningite, internadas no Hospital Couto Maia, na cidade de Salvador-Bahia, no período de janeiro-1990 a dezembro-1992. Crises epilépticas, diminuiçäo do nível de consciência e rigidez de nuca foram mais frequentes no grupo com meningite bacteriana. Glicorraquia menor que 45 mg/dL, proteinorraquia igual ou superior a 140 mg/Dl e celularidade liquórica superior a 600 cels/mm3 mostraram-se preditores de meningite piogênica. A análise de curva ROC foi utilizada para estabelecer o melhor ponto de corte nas medidas liquóricas de celularidade, proteínas e glicose capaz de predizer meningite bacteriana. Os resultados encontrados enfatizam que informaçöes clínicas, obtidas com a anamnese e o exame neurológico, e liquóricas simples, definidas pelos níveis de proteína, glicose e análise da celularidade, podem ser utilizadas como medidas de grande acurácia para diferenciar meningite piogênica de asséptica em crianças.

level of Interleukin 6 in septic and aseptic meningitis

In this study the level of interleukin-6 [IL[6]] was evaluated in cerebrospinal fluid [CSF] and serum of septic [n=14] and aseptic meningitis [n=16] patients, in addition to its evaluation in 10 controls. CSF IL6 was elevated in 85.7% of patients with septic meningitis [SM] [mean 1471. 4 pg/ml] and in 43.7% of aseptic meningitis [AM] patients [mean 192.8 pg/ml], the difference in between was significant [P< 0. 0001]. Elevation of serum IL[6] was found in 28. 6% of the SM group [means 192.8 pg/ml] and none of the AM group [mean 122.5]. CRP was elevated in CSF and serum of SM and Am groups. Positive correlation was found between IL[6] and CRP in CSF and serum but not with other inflammatory parameters. It is concluded that marked elevation of IL[6] in patients with meningitis suggest a septic aetiology. It is also claimed that IL[6] plays a role in aseptic meningitis which is believed to be dependant on the causative agent