Abstract
Introduction: Meningitis is a neurological emergency with high mortality and morbidity in the past few years. It is highly desirable to have tools which could be used to diagnose and differentiate between bacterial and non bacterial meningitis with high accuracy. In the best of our knowledge, diagnostic uses of CSF & serum CRP estimation in differentiating bacterial and non bacterial meningitis have been evaluated in very few studies in our country and hence the present study was conducted.
Aims: Our aim was to estimate the levels of CRP in CSF and serum in patients of meningitis to differentiate various types of meningitis.
Material & Method: The present case control study was conducted in dept of medicine J.L.N. Medical College & Hospital, Ajmer. We include 60 patients each in both study and control group. These patients were further divided into three groups as Pyogenic meningitis (PM) group, Tubercular meningitis (TBM) group and viral meningitis (VM) group.
Result: CSF CRP qualitative test was positive in 83.33% cases of PM group while this was negative in all other groups. Serum CRP qualitative test was 100% positive in PM and TBM groups. This was negative in all cases of VM and control groups. In PM group CSF CRP level was 24± 14.98 mg/L (range<6-96 mg/L). In TBM, VM and control groups levels were <6mg/L. In PM group serum CRP level was 128± 110.23 mg/L (range 24-384 mg/L). In TBM group level was 25.85±10.36 mg/L (range 12-48mg/L). In VM and control groups levels were <6mg/L in all cases. Serum CRP value was highly significant in PM and TBM groups in comparison of VM and Control groups. There was no difference between PM and TBM group. CSF CRP level was highly significant in PM group in comparison of TBM, VM and Control groups. There was no difference in TBM groups when compared with VM and Control groups.
Conclusion: CSF CRP estimation was highly sensitive to diagnose and differentiate pyogenic meningitis from tubercular and viral meningitis, while serum CRP was highly sensitive to diagnose and differentiate pyogenic and tubercular meningitis from viral meningitis.
References
- Abramson J.S., Hampton KD. The use of C-reactive protein for differentiating meningitis from other central nervous system disease. J. Infect Dis. 1985;151:854-858.
- Ahmed P., Ali S.M., Fakhir S. C-reactive protein in CNS infection. Indian Pediatr 1991;28:1167-1170.
- Benjamin D.R. Olpheim K.E., Brewer L. is C-reactive protein useful in the management of children with suspected bacterial meningitis. Am. J. Clin. Pathol, 1984;81:779-782.
- Bhatt B.V., Verma K, Puri R.K., et al. Prognostic indictors in pyogenic meningitis. Indian Pediatr 1984; 24:977-983.
- Clarke D., Cost K. Use of serum C-reactive protein in differentiating septic from aseptic meningitis in children. J. Pediatr 1983; 102; 718-720.
- Corrall C.J., Pepple J.M., Moxon E.R., Hughes W.T. C-reactive protein in cerebrospinal fluid of children with meningitis. J. Pediatr 1981; 99:365-369.
- De Beer F.C., Kristen G.F. Value of C-reactive protein measurement in bacterial tuberculous, and viral meningitis. Arch. Dis. Child 1984;59:653-656.
- Donald P.R., Strachan A.F. CSF CRP in infective meningitis in childhood. J. Lab. Clin. Med. 1985;106:424-427.
- Finlay F.O., Witherow H., Rudd PT: Latex agglutination testing in bacterial meningitis. Arch. Dis. Child 73:160;1995.
- Kaldor J., Asznowicz R., Buist DGP. Latex agglutination in diagnosis of bacterial infections with special reference to patient with meningitis and septicemia. Am. J. Clin. Pathol 1977;68:284-289.
- Kishore R, Dwevedi R.N., Chandra R. Study of C-reactive protein level in CSF as a diagnostic marker in meningitis. JAPI Jan. 1999; Vol. 47:100.
- Macfarlane D.E., Narla V.R. Cerebrospinal fluid C-reactive protein in the laboratory diagnosis of bacterial meningitis. Acta Pediatr Scand 1985;74:560-563.
- Mishra O.P. Loiwal V, Aliz. CSF-ADA activity and CRP in tuburculous and partially treated bacterial meningitis. Indian Pediatr Aug. 1995; 32(8):886-889.
- Peltola H. C-reactive protein for rapid monitoring of infections of the central nervous system. Lancet 1982; 1: 980-983.
- Peltola H., Valmari P. Serum CRP as a detector of pretreated childhood bacterial meningitis. Neurology Feb. 1985; 35(2): 251-253.
- Pepys M.B. C-reactive protein fifty years on. Lancet 1981; 1:653-56.
- Przyjalkowski W., Lipowski D. CRP and its significance in purulent meningitis. Neurol Neurochir Pol. 1996. Jan- Feb. 30(1):177.
- Roos K.L., Tyler K.L. Bacterial meningitis and other suppurative infection. Harrison's principles of internal medicine. 15th P. 2462-2472.
- Singh U.K. Cerebrospinal fluid C-reactive protein in the diagnosis of meningitis in children. Indian Pediatr 1994; 31:939-42.
- Singh U.K., Sinha R.K., Suman S. C-reactive protein as an indication of complications in bacterial meningitis. Indian Pediatr May 1996; Vol. 33: 373-376.
- Sormunen P., Kallio MJT, Kilpi T, Peltola H. C-reactive protein in useful in distinguishing gram stain negative bacterial meningitis from viral meningitis in children. J. Pediatr 1999; 134:725-729.
- Sutinen J. Sombrero L. Paladin F.J. Etiology of CNS infections in the Philippines and the role of serum CRP in excluding acute bacterial meningitis. Int. J. Infect Dis. 1998-99 winter; 3(2):88-93.
- Vaidya A.K., Wagle N.M. Use of CSF CRP in differentiating bacterial and non-bacterial meningitis. J. Postgrad. Med. 1987;33:58-60.
- Venkatraman VSM, Gorthi S.P., Dhamija R.M. Infection of the central nervous system. J. Postgrad. Med. 2000, Vol., 14:459-482.
Corresponding Author
Dr Urvashi
2/4 Old Heera Bagh Flats, Near SMS Hospital & Narayan Singh Circle. Jaipur Rajasthan 302004
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.254
