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Acute phase reactants and risk of bacterial meningitis among febrile infants and children
1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
Insights
C-reactive protein (CRP) levels, not white blood cell (WBC) counts, improve bacterial meningitis detection in febrile children. CRP measurement aids in diagnosing this serious infection when combined with clinical examination.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Chemistry
Background:
- Bacterial meningitis is a critical diagnosis in febrile children.
- Clinical symptoms and signs have limitations in accurately detecting meningitis.
- Objective markers are needed to enhance diagnostic accuracy.
Purpose of the Study:
- To evaluate if C-reactive protein (CRP) or total peripheral white blood cell (WBC) count can improve the clinical detection of bacterial meningitis in young febrile children.
- To assess the diagnostic utility of CRP and WBC counts as adjuncts to clinical evaluation.
Main Methods:
- A cross-sectional survey was conducted among 160 febrile pediatric patients undergoing lumbar puncture.
- Data collected included central nervous system infection symptoms, meningeal irritation signs, serum CRP levels, and total peripheral WBC counts.
- The study was performed in an urban, university-affiliated general hospital's emergency department and acute care clinic.
Main Results:
- Bacterial meningitis prevalence was 6%.
- CRP levels (>1.0 mg/dL) showed higher sensitivity (0.80) than WBC counts (>15,000/mm3, 0.40) for detecting meningitis.
- Combining physical exam signs with CRP levels achieved 100% sensitivity, while combining symptoms with CRP also yielded 100% sensitivity in specific subgroups.
Conclusions:
- Quantification of CRP significantly enhances the sensitivity of physical examination findings and the specificity of symptoms for diagnosing bacterial meningitis.
- CRP measurement serves as a valuable adjunct to history and physical examination for detecting acute bacterial meningitis in febrile children.
- Total peripheral WBC count was less effective than CRP in improving meningitis detection.
Study Objective:
To test the hypothesis that quantitation of either C-reactive protein (CRP) or the total peripheral WBC count can improve clinical detection of underlying bacterial meningitis among young febrile children.
Design:
Cross-sectional survey of selected symptoms of central nervous system infection, signs of meningeal irritation and/or elevated intracranial pressure, levels of CRP in serum, and total peripheral WBC counts among unselected pediatric patients undergoing lumbar punctures for evaluation of acute febrile illnesses.
Setting:
Emergency department and acute care "walk-in" clinic of an urban, university-affiliated general hospital.
Participants:
160 previously well, acutely febrile infants and children (median age, 6 months).
Results:
The prevalence of bacterial meningitis was 6%. Sensitivity of symptoms was 1.00 and specificity was 0.17. Sensitivity of signs was 0.70 and specificity was 0.81. Of the acute phase reactants, sensitivity of a CRP level of more than 1.0 mg/dL was 0.80, while that of a total peripheral WBC count of more than 15,000/mm3 was 0.40. The presence of signs and/or a CRP level of more than 1.0 mg/dL correctly identified all children with bacterial meningitis (sensitivity, 1.00). The absence of signs and a CRP level of 1.0 mg/dL or less correctly identified 71 of 150 children without bacterial meningitis (specificity, 0.47). Of 125 children without meningeal signs, the combination of symptoms and a CRP level of more than 1.0 mg/dL correctly identified all three children with bacterial meningitis (sensitivity, 1.00). The absence of these symptoms and/or a CRP level of 1.0 mg/dL or less correctly identified 80 of 122 children without bacterial meningitis (specificity, 0.66).
Conclusion:
Quantitation of CRP but not the total peripheral WBC count can increase the sensitivity of physical examination findings and the specificity of symptoms for the diagnosis of bacterial meningitis. Measurement of CRP in serum is useful as an adjunct to history and physical examination for the detection of acute bacterial meningitis in the acutely febrile child.