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C-reactive protein and bacterial meningitis
L E Cuevas1, C A Hart, M Molyneux
1School of Tropical Medicine, Liverpool, U.K.
Abstract:
We have studied prospectively the C-reactive protein values in the cerebrospinal fluid of 54 patients with bacterial meningitis, tuberculous meningitis, and severe malarial infection and convulsions without infections of the central nervous system. CSF CRP above 1 mg/l was observed in 23 out of 28 patients with bacterial meningitis (sensitivity of 82%). The specificity was 73% at the 1 mg/l level. Five out of 19 patients with severe malarial infection had CSF CRP levels above 1 mg/l. Two patients with TB meningitis were also studied. Both of them had CSF CRP above 1 mg/l. Five patients with febrile convulsions or sepsis without meningitis had CSF CRP below 1 mg/l. It is concluded that CSF CRP would not be used as a useful discriminatory test in areas where malaria and TB meningitis are common.
Insights
Cerebrospinal fluid C-reactive protein (CSF CRP) shows potential for diagnosing bacterial meningitis. However, its utility is limited in regions with high rates of tuberculous meningitis and malaria.
Area of Science:
- Neurology
- Infectious Diseases
- Clinical Chemistry
Background:
- Bacterial meningitis is a critical condition requiring rapid diagnosis.
- Distinguishing bacterial meningitis from other neurological infections like tuberculous meningitis and severe malaria can be challenging.
- C-reactive protein (CRP) is an inflammatory marker that can be elevated in infections.
Purpose of the Study:
- To evaluate the diagnostic value of cerebrospinal fluid C-reactive protein (CSF CRP) in differentiating bacterial meningitis from other central nervous system infections.
- To determine the sensitivity and specificity of CSF CRP at a threshold of 1 mg/l.
Main Methods:
- Prospective study of 54 patients.
- Analysis of CSF CRP levels in patients with bacterial meningitis, tuberculous meningitis, severe malaria with convulsions, and non-infectious neurological conditions.
- Comparison of CSF CRP values against confirmed diagnoses.
Main Results:
- CSF CRP above 1 mg/l was found in 82% of bacterial meningitis patients.
- Specificity was 73% at the 1 mg/l threshold.
- Elevated CSF CRP was also observed in tuberculous meningitis and some severe malaria cases, limiting its discriminatory power.
Conclusions:
- CSF CRP is a sensitive marker for bacterial meningitis but lacks specificity in areas where malaria and tuberculous meningitis are prevalent.
- CSF CRP alone is not a reliable discriminatory test for meningitis in endemic regions co-endemic for malaria and TB.