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Reassessing the Value of CSF Protein and Glucose Measurement in Pediatric Infectious Meningitis

Wesley N McLaughlin1, Molly Lamb2, James Gaensbauer3

  • 1aDepartment of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.

Hospital Pediatrics
|April 4, 2022
PubMed
Abstract

Insights

Infectious meningitis (IM) in children is rare. Multiplex PCR and white blood cell counts effectively predict IM, with CSF protein and glucose offering little additional diagnostic value. Targeted testing may improve care.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Diagnostics
  • Microbiology

Background:

  • Infectious meningitis (IM) incidence in US children is declining.
  • Rapid multiplex PCR tests are becoming more accessible for diagnosing IM.
  • Traditional cerebrospinal fluid (CSF) tests include white blood cell count (WBC), protein, and glucose levels.

Purpose of the Study:

  • To evaluate the added diagnostic value of CSF protein and glucose tests for predicting IM in children.
  • To compare the predictive performance of CSF protein and glucose with CSF WBC and multiplex PCR.
  • To assess the impact of these tests on medical decision-making in suspected IM cases.

Main Methods:

  • Retrospective review of CSF results from pediatric patients (0-18 years) at a US children's hospital (October 2015 - August 2017).
  • Exclusion of noninfectious evaluations.
  • Calculation of test characteristics (sensitivity, specificity, PPV, NPV) for CSF WBC, protein, and glucose, individually and in combination.
  • Chart review to determine the consideration of protein and glucose in medical decision-making (MDM).

Main Results:

  • A total of 735 patients were analyzed; 45 (6.1%) had confirmed IM.
  • Multiplex PCR and/or CSF WBC correctly identified all IM cases.
  • CSF glucose provided no additional predictive value when combined with CSF WBC.
  • CSF protein did not improve sensitivity but decreased specificity, PPV, and NPV compared to CSF WBC alone.
  • Abnormal protein was noted in MDM for 6 patients, always alongside elevated WBC; glucose was not mentioned in MDM.

Conclusions:

  • Multiplex PCR and CSF WBC are likely sufficient for predicting meningitis in low-incidence pediatric populations.
  • CSF protein and glucose tests offer limited additional diagnostic information for IM.
  • Optimizing the use of protein and glucose testing in specific clinical scenarios could enhance value-based care.

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