Serum procalcitonin in Egyptian patients with acute meningitis and a negative direct cerebrospinal fluid examination (original) (raw)
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The Journal of Pediatrics, 2006
Objective To identify the biologic tests that best distinguish between bacterial and aseptic meningitis in an emergency department (ED). Study design All children hospitalized for bacterial meningitis between 1995 and 2004 or for aseptic meningitis between 2000 and 2004 were included in a retrospective cohort study. Predictive values of blood (C-reactive protein, procalcitonin [PCT], white blood cell [WBC] count, neutrophil count) and cerebrospinal fluid (CSF) findings (protein, glucose, WBC count, neutrophil count) available in the ED were determined. Tests with the best predictive value were identified by using univariate and multivariate analyses and ROC curves comparison. Results Among the 167 patients included, 21 had bacterial meningitis. The CSF gram-stain and bacterial antigen test had 86% and 60% sensitivity rates, respectively. PCT (>0.5 ng/mL) and CSF protein (>0.5 g/L) were the best biologic tests, with 89% and 86% sensitivity rates, 89% and 78% specificity rates, adjusted odds ratios of 108 (95% CI, 15-772) and 34 (95% CI, 5-217), and areas under the ROC curves of 0.95 and 0.93, respectively. Conclusion PCT and CSF protein had the best predictive value to distinguish between bacterial and aseptic meningitis in children.
PURPOSE: Immediate identification of bacterial meningitis (BM) is essential in the emergency department. However, diagnosis of BM from analysis of cerebrospinal fluid has low sensitivity. The goal of this study was to determine the ability of serum procalcitonin (PCT) and C-reactive protein (CRP) for differentiation between BM and non-BM in adult patients. METHODS: This retrospective cohort study, which was conducted from Jan 1 2008 to Sep 30 2011, included patients with a diagnosis of meningitis based on compatible clinical features and cerebrospinal fluid (CSF) culture findings with a CSF leukocyte count > 5 /microL. Measurement of Serum PCT and CRP level was performed on initial admission to the emergency department. Patients were divided into two groups, according to the type of meningitis: BM or non-BM. Clinical features, laboratory results, including CSF results, serum PCT, and CRP levels were assessed. RESULTS: A total of 63 patients (age, 49+/-19) with confirmed meningiti...
2014
Objective: Acute bacterial meningitis in pediatrics remains a serious and potentially lethal disease. Its prognosis is critically dependent on rapid diagnosis and treatment. The use of biological markers, like procalcitonin, has been proposed to facilitate the accuracy of the initial diagnosis of bacterial meningitis. The aim of this study was assessment the diagnostic values of serum procalcitonin (PCT) assay in the diagnosis and differentiation of acute bacterial from non bacterial meningitis. Methods: 45 patients with suspicion of meningitis were enrolled in the study and were clinically evaluated and investigated by lumbar punctures for cerebrospinal fluid analysis, C-reactive protein and differential leukocyte count. Patients with clinical and laboratory suggestion of bacterial causes were regarded as bacterial meningitis group (29 patients), and those who were suggestive of nonbacterial causes were regarded as nonbacterial group (16 patients). Findings: Serum procalcitonin lev...
Iranian Journal of Pediatrics
Acute bacterial meningitis in pediatrics remains a serious and potentially lethal disease. Its prognosis is critically dependent on rapid diagnosis and treatment. The use of biological markers, like procalcitonin, has been proposed to facilitate the accuracy of the initial diagnosis of bacterial meningitis. The aim of this study was assessment the diagnostic values of serum procalcitonin (PCT) assay in the diagnosis and differentiation of acute bacterial from non bacterial meningitis. 45 patients with suspicion of meningitis were enrolled in the study and were clinically evaluated and investigated by lumbar punctures for cerebrospinal fluid analysis, C-reactive protein and differential leukocyte count. Patients with clinical and laboratory suggestion of bacterial causes were regarded as bacterial meningitis group (29 patients), and those who were suggestive of nonbacterial causes were regarded as nonbacterial group (16 patients). Serum procalcitonin levels were significantly higher ...
A Study of Serum Procalcitonin Level in Hospitalised Pyogenic Bacterial Meningitis Patients
INTRODUCTION The present study was to pool and analyze the results of all the reported studies to determine the true diagnostic accuracy of PCT in adult patients with suspected meningitis. AIM AND OBJECTIVE To predict pyogenic bacterial meningitis on the basis of independent factor like serum procalcitonin against CSF analysis (WBC, biochemistry, CSF culture and gram staining). METHOD: Observational diagnostic test evaluation study of 64 clinically suspected cases of meningitis had taken consecutively between June 2017-August 2018. RESULTS: We analysed 64 cases with suspected meningitis where 45 (70.31%) were male; mean age was 42.75±17.47 years. In that 42 patients diagnosed with ABM,13 with TBM and 9 with viral meningitis. In the present study mean for CSF procalcitonin in ABM was 4.87 ± 6.58, in TBM was 0.13±0.17and in viral meningitis was 0.28±0.34. Patients with ABM had raised serum procalcitonin as compared to TBM and viral meningitis. This finding was statistically significant, i.e. P<0.007. Out of 42 ABM patients 37 (88.57%) showed neutrophilic pleocytosis and raised protein in CSF along with raised serum PCT. Additionally, PCT levels would be expected to decrease in patients receiving antibiotics prior to testing. In our study out of 42 patients of ABM 12 had taken antibiotic and 30 did not taken in previous 72 hrs. In 30 patients those who have not taken antibiotic 27(90%) had raised PCT. CONCLUSION: Based on the findings of this study it was observed that Serum PCT is a powerful diagnostic test for the assessment of suspected meningitis, allowing rapid differentiation between bacterial and viral aetiologies, and earlier initiation of appropriate and necessary therapies.
Infection, 2001
The value of serum and cerebrospinal fluid (CSF) procalcitonin for differentiating between acute bacterial and viral meningitis was assessed and compared to other parameters which are usually used in clinical practice. Patients: 45 adult patients (20 with bacterial and 25 with tick-borne encephalitis, TBE) were included in this prospective study. Results: The median serum procalcitonin level in patients with bacterial meningitis was 6.45 ng/ml (range 0.25-43.76 ng/ml) and in the group with viral meningitis 0.27 ng/ml (range 0.05-0.44 ng/ml). 11 patients with bacterial meningitis had an elevated procalcitonin concentration not only in serum, but also in CSF. A serum procalcitonin level > 0.5 ng/ml had a positive predictive value for bacterial meningitis of 100% and a negative predictive value of 93%, while corresponding values for CSF procalcitonin were 100% and 74%, respectively. Conclusion: Serum and CSF procalcitonin concentrations > 0.5 ng/ml appear to be a reliable indicator of bacterial central nervous system (CNS) infection, with maximal positive predictive values and high negative predictive values.
High Sensitivity and Specificity of Serum Procalcitonin Levels in Adults with Bacterial Meningitis
Clinical Infectious Diseases, 1999
It was shown in children that serum procalcitonin was the best marker to use to differentiate bacterial from viral meningitis. To evaluate procalcitonin in the diagnosis of acute bacterial and viral meningitis, we conducted a prospective study including adult patients who were suspected of having meningitis and who were admitted to an emergency department. Cerebrospinal fluid (CSF) and serum levels of procalcitonin were measured in 105 consecutive patients. The diagnosis of meningitis was based on clinical findings, gram staining, culture, and chemical analysis of CSF. Twenty-three patients had bacterial meningitis, 57 had viral meningitis, and 25 did not have meningitis. Bacteriologic and chemical analysis of CSF did not allow correct differentiation of viral from bacterial meningitis. On the other hand, a serum procalcitonin level ú0.2 ng/mL had a sensitivity and specificity of up to 100% in the diagnosis of bacterial meningitis. Serum procalcitonin levels seem to be the best marker in differentiating between bacterial and viral meningitis in adults.
2014
Bacterial meningitis is a serious infection of the central nervous system. On the other hand, aseptic meningitis is a benign self-limited disease. Differentiating both diseases is of great importance. Earlier studies using urine reagent strips and procalcitonin (PCT) for diagnosis of meningitis had given a high sensitivity and specificity rates reaching 100%. The main aim of this study was to evaluate the usefulness of two bedside diagnostic tests in the diagnosis of meningitis. These were urine reagent strips and semi-quantitative procalcitonin (PCT-Q) test. One hundred patients with clinical and laboratory data suggesting of meningitis were included in this study. Complete biological and biochemical laboratory examination of cerebrospinal fluid (CSF), and serum inflammatory markers were done. According to this work, the 100 patients were classified into 64 patients with bacterial meningitis and 36 patients with aseptic meningitis. The CSF samples were tested using urine reagent st...
International Journal of Contemporary Pediatrics
Background: Procalcitonin in cerebrospinal fluid has been evaluated with regard to its usefulness in distinguishing between the possible causative organisms for infections. CSF PCT as a diagnostic marker has also been evaluated for differentiating bacterial from viral meningitis with conflicting results obtained so far. The current study was designed to see the role of procalcitonin as diagnostic marker and in differentiating bacterial from aseptic meningitis in pediatric age group.Methods: Children from 5 months to 15 years of age who were suspected cases of meningitis and were admitted to Pediatric Department in SKIMS Srinagar, Jammu and Kashmir were included in this case control prospective study conducted from 2014 to 2016. The total number of 200 children participated in the study among which 100 were cases and 100 controls. Serum and CSF PCT was measured by a fluorescence immunoassay using QDX Instacheck with a detection limit of 0.25-100 ng/ml. Data was analyzed by using stan...
The Role of Procalcitonin in the Diagnosis of Meningitis: A Literature Review
Journal of Clinical Medicine
Objective: To review the current published literature on the use of procalcitonin as a diagnostic and prognostic marker in adult patients with meningitis. Methods: We conducted a PubMed search to identify all relevant publications regarding the diagnostic and prognostic value of serum procalcitonin in patients with a known or suspected central nervous system infection. We also reviewed the bibliographies of all identified manuscripts in an attempt to identify additional relevant references. Results: A significant body of evidence suggests that serum procalcitonin has a promising role and can be a useful biomarker in the assessment of patients with meningitis. Conclusions: Our literature review suggests that data on the role of Cerebrospinal Fluid (CSF) procalcitonin are limited, whereas serum procalcitonin (S-PCT) is probably a useful tool in the evaluation of patients with a known or suspected central nervous system infection and can help distinguish between bacterial and viral meningitis.