Diagnostic Utility of Cerebrospinal Fluid Procalcitonin in Neonatal Meningitis

Abstract We aimed to study the diagnostic utility of cerebrospinal fluid (CSF) procalcitonin in neonates with meningitis. All the neonates with sepsis who qualified for lumbar puncture were prospectively evaluated. The neonates were classified as Meningitis and No meningitis group based on predefined criteria. CSF procalcitonin was estimated in these neonates along with cytological and biochemical parameters. A total of 113 neonates were included in the study with 29 in meningitis group and 84 in no meningitis group. The median procalcitonin levels was higher in babies with meningitis as compared to those without meningitis [0.194 (0.034 - 0.534) in meningitis group vs 0.012 (0.012-0.012) ng/ml in no meningitis group, p< 0.001]. The area under curve (AUC) for CSF procalcitonin was 0.867 (0.77 -0.95) and at a cut off level of 0.120 ng/ml CSF procalcitonin had a sensitivity of 83%, specificity of 84% and positive and negative predictive likelihood ratios of 5.35 and 0.20 respectively for the diagnosis of meningitis.Conclusion: CSF procalcitonin has a good diagnostic accuracy similar to other parameters in the diagnosis of neonatal meningitis and can be considered as an additional diagnostic marker particularly, when CSF culture is negative and cytochemical analysis is inconclusive.Trial registration number and date: CTRI/2018/09/015720 ; 14/09/2018

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Differentiating School-Aged Children With and Without Language Impairment Using Tense and Grammaticality Measures From a Narrative Task

Journal of Speech Language and Hearing Research ◽

10.1044/2015_jslhr-l-15-0066 ◽

2016 ◽

Vol 59 (2) ◽

pp. 317-329 ◽

Cited By ~ 21

Author(s):

Ling-Yu Guo ◽

Phyllis Schneider

Keyword(s):

Language Development ◽

Diagnostic Accuracy ◽

Language Impairment ◽

Likelihood Ratios ◽

Verb Morphology ◽

Story Generation ◽

School Aged Children ◽

Sensitive Tool ◽

Good Diagnostic Accuracy ◽

Sensitivity Specificity

Purpose To determine the diagnostic accuracy of the finite verb morphology composite (FVMC), number of errors per C-unit (Errors/CU), and percent grammatical C-units (PGCUs) in differentiating school-aged children with language impairment (LI) and those with typical language development (TL). Method Participants were 61 six-year-olds (50 TL, 11 LI) and 67 eight-year-olds (50 TL, 17 LI). Narrative samples were collected using a story-generation format. FVMC, Errors/CU, and PGCUs were computed from the samples. Results All of the three measures showed acceptable to good diagnostic accuracy at age 6, but only PGCUs showed acceptable diagnostic accuracy at age 8 when sensitivity, specificity, and likelihood ratios were considered. Conclusion FVMC, Errors/CU, and PGCUs can all be used in combination with other tools to identify school-aged children with LI. However, FVMC and Errors/CU may be an appropriate diagnostic tool up to age 6. PGCUs, in contrast, may be a sensitive tool for identifying children with LI at least up to age 8 years.

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Differentiating patterns of oligoclonal banding in the cerebrospinal fluid improves diagnostic utility for multiple sclerosis

Pathology ◽

10.1097/pat.0b013e3283511a87 ◽

2012 ◽

Vol 44 (3) ◽

pp. 248-250 ◽

Cited By ~ 6

Author(s):

Ming-Wei Lin ◽

Dan Suan ◽

Kerry Lenton ◽

Tony Henniker ◽

Therese Burke ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cerebrospinal Fluid ◽

Diagnostic Utility ◽

Oligoclonal Banding

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Cerebrospinal Fluid Tyrosine and 3,4-Dihydroxyphenylacetic Acid Levels in Migraine Patients

Cephalalgia ◽

10.1046/j.1468-2982.1996.1601056.x ◽

1996 ◽

Vol 16 (1) ◽

pp. 56-61 ◽

Cited By ~ 17

Author(s):

J Castillo ◽

F Martínez ◽

C Suárez ◽

J Naveiro ◽

M Lema ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Migraine With Aura ◽

Biochemical Parameters ◽

Migraine Without Aura ◽

Control Population ◽

Dopaminergic Neurotransmission ◽

Control Subjects ◽

Dihydroxyphenylacetic Acid ◽

Csf Concentration

We studied biochemical parameters related with central dopaminergic neurotransmission in migraine patients during crisis. We determined tyrosine and 3,4-dihydroxyphenylacetic acid (DOPAC) levels in cerebrospinal fluid (CSF) of 47 patients, 29 suffering migraine without aura and 18 suffering migraine with aura, comparing them with 27 control subjects. Tyrosine levels did not differ significantly between patients and controls. The CSF concentration of DOPAC was 0.73±0.55 ng/ml in the control population, 3.84±2.08 ng/ml in patients with migraine without aura and 3.30±l.49ng/ml in patients suffering migraine with aura. The concentration of DOPAC correlated positively with the intensity of headache. These results suggest that patients with migraine have a central dopaminergic hyperfunction, probably related to a coexisting central dysfunction of noradrenergic neurotransmision.

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Kanamycin and Gentamicin Treatment of Neonatal Sepsis and Meningitis

PEDIATRICS ◽

10.1542/peds.56.5.695 ◽

1975 ◽

Vol 56 (5) ◽

pp. 695-699

Author(s):

Margan J. Chang ◽

Marilyn Escobedo ◽

Donald C. Anderson ◽

Laura Hillman ◽

Ralph D. Feigin

Keyword(s):

Cerebrospinal Fluid ◽

Neonatal Sepsis ◽

Aminoglycoside Antibiotics ◽

Neonatal Meningitis ◽

Serum Concentrations ◽

Gram Negative ◽

Assay Procedure ◽

Gentamicin Treatment ◽

Alternative Approaches

Mortality from neonatal meningitis due to gram-negative microorganisms remains 50% despite use of aminoglycoside antibiotics. Blood was obtained on 238 occasions from 77 neonates with putative or documented sepsis; paired blood and cerebrospinal fluid (CSF) samples were obtained on 14 occasions from ten neonates with meningitis. Kanamycin and gentamicin were measured by a radioisotopic assay procedure. Kanamycin was administered at 15 mg/kg/day in three divided doses intravenously; serum concentrations peaked at one hour (mean, 7.77µg/ml). Gentamicin was administered at 7.5 mg/kg/day in three divided doses intravenously; serum concentrations peaked at two hours (mean, 5.34µg/ml). Both aminoglycosides generally were nondetectable within the CSF; survival of neonates with gram-negative meningitis correlated specifically with the sensitivity of their isolates to ampicillin which was administered concurrently. This study suggests that alternative approaches to the treatment of neonatal sepsis should be explored; administration of an antibiotic which crosses the blood-cerebrospinal fluid barrier more readily should be considered.

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The cerebrospinal fluid immunoglobulin G index as a diagnostic aid in multiple sclerosis: a Bayesian approach.

Clinical Chemistry ◽

10.1093/clinchem/28.2.354 ◽

1982 ◽

Vol 28 (2) ◽

pp. 354-355 ◽

Cited By ~ 8

Author(s):

E A Hische ◽

H J van der Helm ◽

H K van Walbeek

Keyword(s):

Multiple Sclerosis ◽

Cerebrospinal Fluid ◽

Immunoglobulin G ◽

Graphical Representation ◽

Likelihood Ratios ◽

Serum Samples ◽

Predictive Values ◽

Definite Multiple Sclerosis ◽

Igg Index ◽

Diagnostic Usefulness

Abstract Having determined immunoglobulin G (IgG) and albumin concentrations in 1100 cerebrospinal fluid and serum samples, we calculated the IgG index. Likelihood ratios for multiple sclerosis were calculated by using a training set consisting of 100 patients with definite multiple sclerosis and one consisting of 97 patients suffering from diseases from which multiple sclerosis must be differentiated. Predictive values for multiple sclerosis, given different values for the IgG index, are given in a graphical representation of Bayes' theorem. We conclude that this approach increases the diagnostic usefulness of the IgG index for the diagnosis of multiple sclerosis.

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Specificity and Diagnostic Utility of Cerebrospinal Fluid CXCL13 in Lyme Neuroborreliosis

Clinical Infectious Diseases ◽

10.1093/cid/ciaa335 ◽

2020 ◽

Cited By ~ 1

Author(s):

Elizabeth A Eckman ◽

Dana M Clausen ◽

Aimee R Herdt ◽

Javier Pacheco-Quinto ◽

John J Halperin

Keyword(s):

Cerebrospinal Fluid ◽

Diagnostic Marker ◽

Leukocyte Count ◽

Rank Correlation ◽

Lyme Neuroborreliosis ◽

Early Infection ◽

Igg Synthesis ◽

Specific Igg ◽

Active Inflammation ◽

Spearman Rank Correlation Test

Abstract Background Demonstration of intrathecal production of Borrelia-specific antibodies (ITAb) is considered the most specific diagnostic marker of Lyme neuroborreliosis (LNB). Limitations include delayed detectability in early infection and continued presence long after successful treatment. Markers of active inflammation—increased cerebrospinal fluid (CSF) leukocytes, protein, and CXCL13—provide nonspecific markers of active infection. To assess the utility of CSF CXCL13, we measured its concentration in 132 patients with a broad spectrum of neuroinflammatory disorders, including LNB. Methods CSF CXCL13 was measured by immunoassay. Spearman rank correlation test was performed to explore its relationship to conventional markers of neuroinflammation and Borrelia-specific ITAb production. Results In non-LNB neuroinflammatory disorders, CSF CXCL13 elevation correlated with CSF immunoglobulin G (IgG) synthesis and leukocyte count. In LNB, CXCL13 concentration was far greater than expected from overall CSF IgG synthesis, and correlated with Borrelia-specific ITAb synthesis. Median CSF CXCL13 concentration in ITAb-positive LNB patients was > 500 times greater than in any other group. Conclusions Intrathecal CXCL13 and IgG production are closely interrelated. CXCL13 is disproportionately increased in “definite LNB,” defined as having demonstrable Borrelia-specific ITAb, but not “probable LNB,” without ITAb. This disproportionate increase may help identify patients with very early infection or those with active vs treated LNB, or may help to differentiate ITAb-defined active LNB from other neuroinflammatory disorders. However, its reported specificity is closely related to the diagnostic requirement for ITAb. It may add little specificity to the demonstration of a pleocytosis or increased overall or specific IgG production in the CSF.

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Emerging Infection with Elizabethkingia meningoseptica in Neonate. A Case Report

The Journal of Critical Care Medicine ◽

10.2478/jccm-2018-0013 ◽

2018 ◽

Vol 4 (3) ◽

pp. 96-100

Author(s):

Manuela Arbune ◽

Silvia Fotea ◽

Aurel Nechita ◽

Victorita Stefanescu

Keyword(s):

Cerebrospinal Fluid ◽

Intensive Care ◽

Case Report ◽

Clinical Condition ◽

Neonatal Intensive Care ◽

Severe Infection ◽

Neonatal Meningitis ◽

Elizabethkingia Meningoseptica ◽

Risk Of Mortality ◽

Febrile Episodes

Abstract Background: Elizabethkingia meningoseptica are Gram-negative rod bacteria which are commonly found in the environment. The bacteria have also been associated with nosocomial infections, having been isolated on contaminated medical equipment, especially in neonatal wards. Case report: Here, we present the case of a premature female infant born at 33 weeks’ gestational age, with neonatal meningitis. The onset was marked by fever, in the 5th day of life, while in the Neonatal Intensive Care Unit. The patient was commenced on Gentamicin and Ampicillin, but her clinical condition worsened. Psychomotor agitation and food refusal developed in the 10th day of life, and a diagnosis of bacterial meningitis was made based on clinical and cerebrospinal fluid findings. A strain of Elizabethkingia meningoseptica sensitive to Vancomycin, Rifampicin and Clarithromycin was isolated from cerebrospinal fluid. First-line antibiotic therapy with Meropenem and Vancomycin was adjusted by replacing Meronem with Piperacillin/Tazobactam and Rifampicin. The patient’s clinical condition improved, although some isolated febrile episodes were still present. The cerebrospinal fluid was normalized after 6 weeks of antibiotic treatment, although periventriculitis and tetraventricular hydrocephalus were revealed by imaging studies. Neurosurgical drainage was necessary. Conclusion: Elizabethkingia meningoseptica can cause severe infection, with high risk of mortality and neurological sequelae in neonates. Intensive care and multidisciplinary interventions are crucial for case management.

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Interleukin 6 in Cerebrospinal Fluid of Patients with Meningitis is not a Useful Diagnostic Marker in the Differential Diagnosis of Meningitis

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/000456329703400206 ◽

1997 ◽

Vol 34 (2) ◽

pp. 165-169 ◽

Cited By ~ 14

Author(s):

L F López-Cortés ◽

M Cruz-Ruiz ◽

J Gómez-Mateos ◽

D Jiménez-Hernández ◽

P Viciana-Fernández ◽

...

Keyword(s):

Central Nervous System ◽

Monoclonal Antibody ◽

Cerebrospinal Fluid ◽

Nervous System ◽

Differential Diagnosis ◽

Interleukin 6 ◽

Diagnostic Marker ◽

Neurological Diseases ◽

Central Nervous System Infections ◽

Pyogenic Meningitis

We assayed interleukin 6 (IL-6) concentrations in cerebrospinal fluid (CSF) from patients affected by meningitis of different aetiologies, and verified whether IL-6 can be used as a diagnostic marker in the differential diagnosis of meningitis. We used a monoclonal antibody enzyme immunoassay to test 98 CSF samples classified as pyogenic (15), viral (15), self-resolving aseptic meningitis (20), other infectious meningitis (9), neoplastic (4) and normal CSF from patients with (20) and without (15) non-infectious neurological diseases. CSF IL-6 concentrations were increased in pyogenic meningitis (100%) and in more than 50% of viral and other subarachnoid space infections, and rarely in patients without central nervous system infections. Though patients affected by pyogenic meningitis showed the highest levels of CSF IL-6, only a cut-off point ≥10000 pg/mL was able to discriminate pyogenic meningitis from those of other aetiologies with a specificity ≥94% and a positive predictive value of ≥0·75 but the sensitivity was ≤60%. Therefore, CSF IL-6 concentration is not a good diagnostic marker in the differential diagnosis of meningitis.

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