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Childhood Bacterial Meningitis and Usefulness of C-reactive Protein
P L Prasad1, Mng Nair2, A T Kalghatgi3
1Senior Adviser (Paediatrics), Command Hospital(Central Command), Lucknow.
Insights
C-reactive protein (CRP) is a valuable marker for early bacterial meningitis diagnosis. Elevated serum and CSF CRP levels accurately identify bacterial meningitis, aiding in timely treatment and reducing antibiotic overuse.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Biochemistry
- Diagnostic Microbiology
Background:
- Bacterial meningitis diagnosis can be challenging, with C-reactive protein (CRP) levels rising rapidly in the initial 24-48 hours.
- A prospective study was conducted in a tertiary care hospital to evaluate the utility of CRP in the early diagnosis of bacterial meningitis.
Purpose of the Study:
- To ascertain the usefulness of C-reactive protein (CRP) in the early diagnosis of bacterial meningitis in children.
- To evaluate the diagnostic accuracy of serum and cerebrospinal fluid (CSF) CRP levels against established diagnostic criteria.
Main Methods:
- Children with suspected meningitis underwent comprehensive clinical, biochemical, cytological, and bacteriological investigations.
- Blood and CSF samples were analyzed for CRP using a latex agglutination test.
- CSF gram staining, culture, and biochemical results served as the gold standard for diagnosis.
Main Results:
- Out of 63 meningitis cases, 38 were bacterial, 21 tubercular, and 4 viral. H. influenza was the most common bacterial isolate.
- Elevated CSF CRP was observed in 33 bacterial and 2 tubercular meningitis cases.
- Elevated serum CRP was noted in 29 bacterial and 8 tubercular meningitis cases, with negative results in viral meningitis.
Conclusions:
- Quantitative and qualitative CRP assays are simple, rapid (10 minutes), and require minimal blood (0.2 ml).
- CRP testing demonstrates high sensitivity (96%) and specificity (100%) for bacterial meningitis.
- Utilizing CRP testing can significantly reduce the unnecessary administration of antibiotics to children.
Background:
C-reactive protein raises rapidly in the first 24-48 hours of occurrence of bacterial meningitis and in large incremental increases thereafter. This prospective study was undertaken in a tertiary care hospital of Armed Forces to ascertain the usefulness of C-reactive protein in early diagnosis of bacterial meningitis.
Methods:
All children admitted during the period of study, with clinical suspicion of meningitis were clinically, biochemically, cytologically and bacteriologically investigated to clinch the diagnosis. Blood and CSF were also sent for C-reactive protein assay by latex agglutination test. CSF gram staining, culture and biochemical results were taken as gold standard. CSF and serum CRP were then evaluated against this gold standard. Statistical analysis was done by Epiinfo 6.
Results:
There were 63 cases of meningitis admitted in the hospital. By gold standard, there were 38 cases of bacterial, 21 cases of tubercular and 4 cases of viral meningitis. H. influenza was the predominant organism grown. CSF C-reactive protein was raised in 33 cases of bacterial and 2 cases of tubercular meningitis. Serum C-reactive protein was raised in 29 cases of bacterial, and eight cases of tubercular meningitis. These tests were negative in all cases of viral meningitis. The sensitivity and specificity of serum and CSF C-reactive protein was 96% and 100%.
Conclusion:
Quantitative and qualitative assay of C-reactive protein is a simple bedside test. It can be completed in 10 minutes and requires only 0.2 ml of blood. This will significantly reduce unnecessary antibiotics to children.
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