C-reactive protein follow-up of children with acute bacterial meningitis

ABSTRACT

Twenty-two children with bacterial meningitis were prospectively studied to follow serum levels of C-reactive protein (CRP) at admission, and the 2nd, 5th and 7th days of treatment, and in the cerebrospinal fluid (CSF) at admission, to investigate whether there is any relationship of its levels with the clinical evolution. CRP was measured by latex agglutination and/or ELISA techniques with detection limits of 0.15mg/L and 0.9mg/L, respectively. Patients were classified according to clinical evolution in two groups uneventful recovery (n=12) and complicated evolution (n=10). Clinical complications observed were relapse of fever (8), persistent fever (4), arthritis (4), ventricle enlargement (2), subdural effusion (1), subdural empyema (1), ataxia (1), cervical hypotonia (1), deafness (1), endophthalmitis (1), accute otitis media (1), secondary skin infection (1) and treatment change due to poor clinical response (1). A significant decrease in CRP levels was observed among the uneventful recovery group after admission. In contrast, in the group with complicated evolution, CRP levels showed either secondary elevation or remained high continously. Mean serum CRP levels were significantly lower in the uneventful recovery group than in the complicated evolution group on the 5th and 7th days. CRP levels below 20mg/L on the 5th and 7th days were associated with an uneventful recovery, and CRP levels higher than 20mg/L on those same days were associated with a complicated clinical evolution (p=0.01* and p=0.0015*, respectively). We conclude that serumm CRP level monitoring in children with bacterial meningitis provides useful and objective information about their clinical evolution. This procedure is inexpensive and suitable for use in endemic areas lacking sophisticated laboratories.