Laboratory-Based Cytological and Biochemical Profile of Cerebrospinal Fluid for Children With Acute Bacterial Meningitis in Bangladesh

An attempt was made to analyze the cerebrospinal fluid (CSF) for a cytological and biochemical profile to identify etiological agents from children with suspected acute bacterial meningitis. The cerebrospinal fluid (CSF) samples from 371 suspected meningitis cases were examined, and the highest bacterial meningitis was found in 52(14.0%) cases in this study. Among a total of 371 samples of CSF, 272(73.3%) were crystal clear, 52(14.0%) were moderately turbid, 47(12.7%) highly turbid. The total leukocyte cell count of the CSF was proportionate to the turbidity. In the case of crystal clear CSF’s, total leukocyte counts (TLC) were normally ranging from <5 to 45 per mm3 with predominant lymphocytes. Moderately turbid fluid showed 46 to 500 cells per mm3 and highly turbid fluid showed from 501 to more than 10,00 cells/mm3. In the latter cases, differential counts demonstrated polymorphonuclear predominance. In addition, about 100% (52 cases) of positive and 12.5% (40/319) of negative cases had CSF protein concentration >100 mg/dL. CSF protein concentration greater than 100 mg/dl and sugar level below 40 mg/dl were considered as suspected bacterial meningitis in this study. Surprisingly, the C-Reactive Protein (CRP) values were found to be >40 mg/dL in both culturally positive and negative cases. Most of meningitis positive cases showed increased total cell counts as well as protein concentration, and decreased serum sugar concentrations. J. Asiat. Soc. Bangladesh, Sci. 47(2): 137-147, December 2021

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The Use of Cytokine and C-Reactive Protein Measurements in Cerebrospinal Fluid during Acute Infective Meningitis

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/000456329403100307 ◽

1994 ◽

Vol 31 (3) ◽

pp. 255-261 ◽

Cited By ~ 26

Author(s):

M Stearman ◽

H J Southgate

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

White Cell Count ◽

Correct Diagnosis ◽

Viral Meningitis ◽

Acute Bacterial Meningitis ◽

Control Group ◽

C Reactive Protein ◽

Reactive Protein ◽

Factor Α

Cerebrospinal fluid (CSF) concentrations of C-reactive protein (CRP), tumour necrosis factor α (TNF), interleukin-6 (IL-6), total protein (TP) and white cell count with differential (WCC) have been measured in 24 patients presenting with acute bacterial or viral meningitis and also in a non-infected, non-inflammed control group ( n = 24). In acute viral meningitis, CRP levels were not raised when compared to controls and there was a discordance between high levels of the primary inflammatory mediators (IL-6 and TNF) and the low measured CRP levels. CRP levels were raised in cases of bacterial meningitis. A concentration of 100 ng/mL CRP had a sensitivity of 87% for bacterial meningitis. TNF concentrations in the CSF were significantly raised in cases of acute bacterial meningitis ( P < 0·001). Smaller but variable elevations were seen in the patients with acute viral meningitis. One patient, who succumbed to bacterial infection, showed low CSF levels of CRP, TNF and WCC but an elevated IL-6 concentration. Another, presenting with low CSF WCC, had raised concentrations of CRP, TNF and IL-6 which pointed to the correct diagnosis of acute bacterial meningitis. The development of methods yielding rapid analysis for these cytokines together with a sensitive assay for CRP in CSF would be a useful adjunct to conventional investigation.

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Evaluation of high sensitivity C-reactive protein assay in cerebrospinal fluid on the Dimension RxL analyzer

Journal of Health Sciences ◽

10.17532/jhsci.2012.57 ◽

2012 ◽

Vol 2 (1) ◽

pp. 13-16

Author(s):

Jozo Ćorić ◽

Aleksandra Pašić ◽

Mirsad Panjeta ◽

Jasminka Mujić

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

High Sensitivity ◽

Acute Bacterial Meningitis ◽

Control Group ◽

C Reactive Protein ◽

Protein Assay ◽

Reactive Protein ◽

The Mean ◽

Low Sensitivity

Introduction: Low sensitivity and specificity in traditional laboratory tests became insufficient for accurate diagnostics and initiation of proper treatment of patients infected with bacterial meningitis. High sensitivity C reactive protein (hsCRP) may be an appropriate supplement for rapid diagnosis of bacterial meningitis. The subject of our investigation was the determination of C- reactive protein in cerebrospinal fluid (CSF) duringacute bacterial meningitis.Methods: HsCRP was analysed by a sensitive immunoturbidimetric assay using the Dimension RxL analyser (Siemens). Cerebrospinal fluid concentrations of C-reactive protein have been measured in 20 patients(age range,1 to 50 years) presenting with acute bacterial meningitis and also in a non-infected, non-inflamed control group (n=25).Results: The accuracy and precision of the method proved to be satisfactory. Repeatability of serial sampling for hsCRP described by coefficient of variation were CV=2.1-4.5%. This assay hsCRP in cerebrospinal fluid demonstrates adequate performance characteristics for routine clinical use. Elevated levels of CRP were found in 95% patients with bacterial meningitis. The mean CRP value in 25 uninfected control group was 0.25 mg/L (range 0.10-0.55). The mean CRP for patients with bacterial meningitis was 21.4 mg/L (range 0.40-100).Conclusions: A sensitive assay for CRP in CSF would be an useful adjunct to conventional investigation of acute infective meningitis.

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Ability of Procalcitonin and C-Reactive Protein for Discriminating between Bacterial and Enteroviral Meningitis in Children Using Decision Tree

BioMed Research International ◽

10.1155/2021/5519436 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Dmitriy Babenko ◽

Aliya Seidullayeva ◽

Dinagul Bayesheva ◽

Bayan Turdalina ◽

Baurzhan Omarkulov ◽

...

Keyword(s):

Decision Making ◽

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Decision Tree ◽

Clinical Signs ◽

Acute Bacterial Meningitis ◽

C Reactive Protein ◽

Public Health Burden ◽

Reactive Protein ◽

Enteroviral Meningitis

Bacterial meningitis (BM) is a public health burden in developing countries, including Central Asia. This disease is characterized by a high mortality rate and serious neurological complications. Delay with the start of adequate therapy is associated with an increase in mortality for patients with acute bacterial meningitis. Cerebrospinal fluid culture, as a gold standard in bacterial meningitis diagnosis, is time-consuming with modest sensitivity, and this is unsuitable for timely decision-making. It has been shown that bacterial meningitis differentiation from viral meningitis could be done through different parameters such as clinical signs and symptoms, laboratory values, such as PCR, including blood and cerebrospinal fluid (CSF) analysis. In this study, we proposed the method for distinguishing the bacterial form of meningitis from enteroviral one. The method is based on the machine learning process deriving making decision rules. The proposed fast-and-frugal trees (FFTree) decision tree approach showed an ability to determine procalcitonin and C-reactive protein (CRP) with cut-off values for distinguishing between bacterial and enteroviral meningitis (EVM) in children. Such a method demonstrated 100% sensitivity, 96% specificity, and 98% accuracy in the differentiation of all cases of bacterial meningitis in this study. These findings and proposed method may be useful for clinicians to facilitate the decision-making process and optimize the diagnostics of meningitis.

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