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Value of C reactive protein measurement in tuberculous, bacterial, and viral meningitis
Abstract:
The value of C reactive protein measurement in the differential diagnosis of meningitis was assessed in a population where tuberculous meningitis is prevalent. C reactive protein was measured serially with a sensitive radioimmunoassay in sera from 31 children with bacterial meningitis, 15 with tuberculous meningitis (6 with miliary tuberculosis), and 28 with viral meningitis. Concentrations of C reactive protein in patients with tuberculous meningitis lay between those of patients with bacterial and viral meningitis--a finding which detracts from the virtually absolute discrimination C reactive protein measurement allows between bacterial and viral meningitis. In all but two of the patients with tuberculous meningitis, C reactive protein concentrations fell rapidly after treatment began and became normal after 10 days. This fall did not, however, exclude the development of hydrocephalus as a complication. Measurement of C reactive protein remains a useful additional parameter in the diagnosis and management of the various types of meningitis.
Insights
C-reactive protein (CRP) levels help differentiate meningitis types. In areas with prevalent tuberculous meningitis, CRP values fall between bacterial and viral meningitis, aiding diagnosis and management.
Area of Science:
- Clinical Medicine
- Infectious Diseases
- Pediatrics
Background:
- Meningitis diagnosis is critical, especially in regions with high rates of tuberculous meningitis.
- C-reactive protein (CRP) is a known inflammatory marker used in diagnosing bacterial versus viral meningitis.
Purpose of the Study:
- To evaluate the utility of C-reactive protein (CRP) measurements in the differential diagnosis of meningitis in a population with a high prevalence of tuberculous meningitis.
- To assess the diagnostic value of CRP in distinguishing between bacterial, tuberculous, and viral meningitis.
Main Methods:
- Serial C-reactive protein (CRP) levels were measured using radioimmunoassay.
- Sera were collected from children diagnosed with bacterial meningitis (31), tuberculous meningitis (15), and viral meningitis (28).
- CRP concentrations were analyzed in relation to meningitis type and treatment response.
Main Results:
- CRP concentrations in tuberculous meningitis cases were intermediate, falling between those observed in bacterial and viral meningitis.
- This intermediate finding reduces the previously observed near-absolute discrimination between bacterial and viral meningitis based on CRP.
- CRP levels decreased rapidly within 10 days of treatment initiation in most tuberculous meningitis patients, but this did not prevent hydrocephalus development.
Conclusions:
- C-reactive protein measurement is a valuable tool for the diagnosis and management of various meningitis types, even in populations with prevalent tuberculous meningitis.
- While CRP aids in differentiating meningitis, its intermediate values in tuberculous meningitis necessitate careful interpretation.
- Serial CRP monitoring can track treatment response in tuberculous meningitis, but does not rule out complications like hydrocephalus.