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C-reactive Protein Follow-up of Children With Acute Bacterial Meningitis
Dias Leite R1, Alves Ribeiro M, Farhat
1Federal University of São Paulo, São Paulo School of Medicine.
Insights
Monitoring C-reactive protein (CRP) levels in children with bacterial meningitis helps predict clinical outcomes. Lower CRP levels on days 5 and 7 indicate recovery, while high levels suggest complications, aiding in treatment decisions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Chemistry
Background:
- Bacterial meningitis is a serious infection in children.
- Early identification of clinical evolution is crucial for effective management.
- C-reactive protein (CRP) is a biomarker of inflammation.
Purpose of the Study:
- To investigate the relationship between C-reactive protein (CRP) levels and the clinical evolution of bacterial meningitis in children.
- To determine if CRP levels can predict recovery or complications.
Main Methods:
- Prospective study of 22 children with bacterial meningitis.
- Serum CRP levels measured at admission and on days 2, 5, and 7 of treatment.
- Cerebrospinal fluid (CSF) CRP measured at admission.
- Patients classified into uneventful recovery and complicated evolution groups.
Main Results:
- Children with uneventful recovery showed a significant fall in serum CRP levels.
- Patients with complicated evolution exhibited persistently high or elevated CRP levels.
- Serum CRP levels below 20mg/L on days 5 and 7 were associated with uneventful recovery (p<0.015).
Conclusions:
- Serum CRP monitoring is a valuable and objective tool for assessing clinical evolution in pediatric bacterial meningitis.
- This cost-effective method is suitable for resource-limited settings.
- CRP levels can help differentiate between uncomplicated and complicated cases, guiding treatment adjustments.
Abstract:
Twenty-two children with bacterial meningitis were prospectively studied to follow C-reactive protein (CRP) in serum at admission, 2nd, 5th and 7th days of treatment, and in the cerebrospinal fluid (CSF) at admission, to investigate if 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), acute otitis media (1), secondary skin infection (1) and treatment change due to poor clinical response (1). A significant fall in CRP serum levels was observed among the uneventful recovery group after admission. Distinctly, in the group with a complicated evolution CRP levels showed either secondary elevation or remained high continuously. Mean serum CRP levels were significantly lower in the uneventful recovery group than in the complicated evolution group on 5th day and on 7th day. CRP levels below 20mg/L on 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 serum CRP levels monitoring in children with bacterial meningitis represents a useful and objective information about the clinical evolution. This procedure is inexpensive and suitable for use in endemic areas lacking sophisticated laboratories.