Urinary Reagent Strip: A Reliable and Rapid Bedside Diagnostic Tool for Meningitis

Meningitis, being one of the life-threatening diseases, always needs timely initiation of treatment to save disability and mortality, and this is greatly dependent on early diagnosis. The gold standard way of diagnosing meningitis is to test cerebrospinal fluid (CSF) by microscopy, biochemistry, and cultures, which always require experts and advanced labs, which are not always present in remote areas of underdeveloped countries. This study primarily aimed to assess the accuracy of urinary reagents in diagnosing bacterial meningitis and its comparison with the gold standard method as this could be used for quick analysis of CSF to diagnose meningitis. This could be a very useful tool in resource-limited settings given its rapid accessibility and cost-effectiveness.

This cross-sectional prospective study was conducted at the Department of Neurology, Punjab Institute of Neurosciences (PINS), Lahore, Pakistan, from December 2, 2020, to June 2, 2021. Both genders and ages 14-70 with suspicion of meningitis were included in this study. Biochemistry and microscopy labeled the patients "positive," with a white blood cell count of 10/mm³, proteins > 45 mg/dL, and glucose > 40 mg/dL in CSF. Positive urine reagent strips were marked as "positive" if glucose levels were > +1 and protein levels were +2 and if leukocyte esterase levels were positive (qualitatively).

Among the 147 patients, 93 (63%) were males, and 54 (37%) were females. The mean age was 41.82±15.5 years. There were 63 (42.86%) positive results on urine reagent strips and 64 (43.54%) positive results on CSF microscopy and biochemistry. Urine reagent strips had diagnostic accuracy of 92.52%, sensitivity of 90.62%, specificity of 93.98%, positive predictive value (PPV) of 92.06%, and negative predictive value (NPV) of 92.86% with significant p-values (0.001).

CSF pleocytosis could be detected using urine reagent strips, which would be useful in settings without the infrastructure to exclude the diagnosis of bacterial meningitis if negative.