C-reactive protein in cerebrospinal fluid and serum: A paraphernalia in the diagnosis of pyogenic meningitis

Abstract Objectives This study aimed to evaluate the positivity of C-reactive protein (CRP) in cerebrospinal fluid (CSF) and serum in children presented with clinical diagnosis of acute encephalitis syndrome (AES). Methods A total of 164 children between 6 months and 14 years with clinical diagnosis of AES were investigated. Qualitative CRP (slide agglutination) was determined in CSF and serum sample of each patient. On the basis of clinical examination and investigations, all the patients were divided into four groups as pyogenic meningitis, viral encephalitis, tuberculous meningitis, and cerebral malaria. The positivity of CRP in CSF and serum were compared in these groups. Results CSF CRP was found to be positive in the majority of patients with pyogenic meningitis and a statistically significant (p ≤ 0.001) association was found between CSF CRP and final diagnosis of AES, while this association was nonsignificant (p = 0.141) in case of serum CRP. When we compared the CSF and serum CRP, serum CRP was found to be more suggestive of tuberculous meningitis, viral encephalitis, and cerebral malaria while CSF CRP was more sensitive and specific for the diagnosis of pyogenic meningitis. Conclusion The sensitivity and specificity of CSF CRP for pyogenic meningitis was quite high. Serum CRP with a high sensitivity can be used as a screening test for different types of meningitis and cerebral malaria; however, its diagnostic accuracy has yet to be established.

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Evaluation of Cerebrospinal Fluid C-Reactive Protein for Differentiating Pyogenic Meningitis from non Pyogenic Meningitis

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v6i8.149 ◽

2018 ◽

Vol 6 (8) ◽

Author(s):

Dr Gagan Gunjan

Keyword(s):

Cerebrospinal Fluid ◽

C Reactive Protein ◽

Pyogenic Meningitis ◽

Reactive Protein

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Acute childhood encephalopathy with prolonged fever, pleocytosis and elevated inflammatory cytokines in the cerebrospinal fluid and transient splenial lesion

Journal of the International Child Neurology Association ◽

10.17724/jicna.2019.166 ◽

2019 ◽

Author(s):

Rena Okada ◽

Yuri Sakaguchi ◽

Takeshi Matsushige ◽

Isamu Kamimaki ◽

Toshiki Takenouchi ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Mental Status ◽

Nationwide Survey ◽

Altered Mental Status ◽

Acute Encephalopathy ◽

C Reactive Protein ◽

Reactive Protein ◽

Prolonged Fever ◽

Splenial Lesion ◽

Male Patients

Background: Acute encephalopathy during childhood represents a highly heterogeneous group of infectious and non-infectious pathologies. According to a recent nationwide survey on acute childhood encephalopathy in Japan, the combination of clinical and radiographic features left approximately half of the affected children unclassified, mainly because of the lack of disease-specific biomarkers. Case: Herein, we document a school-aged boy who manifested with acute encephalopathy that was characterized by a prolonged fever, altered mental status, urinary retention, and intention tremor lasting for more than a month. Accompanying features included syndrome of inappropriate secretion of antidiuretic hormone, pleocytosis with elevated interleukin-6 and interferon-gamma levels in the cerebrospinal fluid, and a transient splenial lesion on neuroimaging. No pathogens were identified, and C-reactive protein was negative throughout his clinical course. This constellation of clinical features was not compatible with any of the existing entities of acute pediatric encephalopathy. Discussion: Our retrospective literature review identified two additional school-aged male patients who exhibited highly similar clinical courses. The prolonged altered mental status with pleocytosis in the cerebrospinal fluid and a transient splenial lesion in the absence of serum inflammatory markers suggest a primary central nervous system pathology. Conclusion: This combination of features defines this presumably new group of acute childhood febrile encephalopathy with prolonged fever and ataxia in school-aged boys.

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Survay of Cerebrospinal Fluid (CSF and C-Reactive Protein (CRP) for Differentiation of Bacterial and Viral Meningitis in Loghman Hakim, Aliasghar and Valiasr Hospitals of Zanjan

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2008.05.1298 ◽

2008 ◽

Vol 12 ◽

pp. e462

Author(s):

D.R. Asadi ◽

B. Amini

Keyword(s):

Cerebrospinal Fluid ◽

Viral Meningitis ◽

C Reactive Protein ◽

Reactive Protein

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C - reactive protein of cerebrospinal fluid, as a sensitive approach for diagnosis of neonatal meningitis

African Health Sciences ◽

10.4314/ahs.v19i3.10 ◽

2019 ◽

Vol 19 (3) ◽

pp. 2372-2377

Author(s):

Shima Javadinia ◽

Mohsen Tabasi ◽

Mehri Naghdalipour ◽

Najmosadat Atefi ◽

Ramin Asgarian ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Aseptic Meningitis ◽

Great Majority ◽

Diagnostic Value ◽

Latex Agglutination ◽

Neonatal Meningitis ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein ◽

Permanent Brain Damage

Background: Meningitis, is a potentially life-threatening condition that can rapidly progress to permanent brain damage, neurologic problems, and even death. Bacteria and viruses cause the great majority of meningitis disease in infants and children. CRP is used mainly as a marker of inflammation.Objective: This study was conducted to assess the diagnostic value of CSF-CRP levels for differentiating between septic (bacterial) and aseptic infantile meningitis.Methods: 49 hospitalized infants aged less than two months with suspected meningitis were enrolled in a cross-sectional analytic study. All of patients underwent lumbar puncture to obtain CSF. smears, cultures, cytological and biochemical analysis and latex agglutination testing were carried out on all CSF samples. Latex agglutination test was carried out on all CSF samples using a commercially available kit. CSF-CRP level of all infants was measured using the immunoturbidometric technique.Results: Of 49 infants in this study, 20 and 29 cases were diagnosed as septic and aseptic meningitis, respectively. The CRP levels were obtained as 0.95±0.68 mg/L in septic and 0.16±0.36 mg/L in aseptic meningitis groups and this difference was statistically significant (p<0.001) between the two groups (0.79±0.32 mg/L). Based on the ROC curve, cut off levels for CRP was obtained 0.17 mg/L. At this level, there was 95% sensitivity and 86% specificity to differentiate septic and aseptic meningitis.Conclusion: CSF-CRP has suitable diagnostic value in distinguishing between infantile bacterial from aseptic meningitis especially in cases of negative bacterial culture of the blood and spinal fluid.Keywords: C-reactive protein, cerebrospinal fluid, septic/aseptic meningitis, infant, diagnostic value.

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