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Category: Volume 06 Issue 03 March 2018
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Title: The use of cerebrospinal fluid C reactive protein and adenosine deaminase as diagnostic markers in differential diagnosis of meningitis

Authors: Soumya Sarathi Mondal, Indranil Sen, Atanu Chandra, Mithun Das

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.115

Abstract

Meningitis is an important public health problem in developing countries with considerable morbidity and mortality. Early categorisation according to the aetiology of meningitis leads to specific treatment with better outcome. Cerebrospinal fluid (CSF) culture is the gold standard but is not easily available and expensive so a rapid but specific test to differentiate types of meningitis is the need of the hour. So this prospective study was carried out in a tertiary care hospital in Eastern India.

50 patients of meningitis based on clinical, radiological and biochemical profile were recruited and serum C reactive protein (CRP), CSF adenosine deaminase (ADA) & CRP were estimated and analysed with respect to conventional parameters. The mean value of serum CRP in pyogenic meningitis was 54.98 which were considerably higher than tubercular and viral counterparts. CSF CRP was also higher in these patients with a mean value 20.35. In tubercular meningitis the mean CSF ADA is 31.16 which were higher compared to other causes. Taking CSF ADA cut off >10IU/L, 17out of 19 patients had higher levels which was quite significant. The sensitivity, specificity, positive predictive value, diagnostic accuracy of CSF CRP is 94.12%, 100%, 100% and 98% respectively and that for CSF ADA is 89.47%, 96.77%, 94.44% and 94% respectively. So CSF ADA & CRP can be used as early and reliable markers to differentiate meningitis.     

Keywords: Meningitis, CSF CRP, CSF ADA, serum CRP.

References

  1. Laboratory methods for the diagnosis of meningitis 2nd Centre for disease control and prevention
  2. Mauricio L Barreto, Maria Glória Teixeira, and Eduardo Hage CarmoInfectious diseases epidemiologyJ Epidemiol Community Health. 2006 Mar; 60(3): 192–195.
  3. Elden J, Yolken RH. C-Reactive Protein and limulus amoebocyte lysate assay in diagnosis of bacterial meningitis. J Paediatr 1986, 108: 423-426
  4. Singh UK. Cerebrospinal fluid C-reactive protein in the diagnosis of meningitis in children. Indian Paediatr 1994, 31: 939-942
  5. Carpenter RR, Petersdorf The clinical spectrum of bacterial meningitis. Am J Med 1962;33:262-275
  6. F C de Beer, G F Kirsten, R P Gie, N Beyers, and A F Strachan. Value of C reactive protein measurement in tuberculous, bacterial, and viral meningitis. Arch Dis Child. 1984 Jul; 59(7): 653–656.
  7. Abramson JS, Hampton KD, Baba S, Wasilaukas BL, Marion MJ. The use of C-reactive protein from cerebrospinal fluid for differentiating meningitis from other central nervous system diseases. J Infect Dis.1985 May;151(5):854-8.
  8. Jansoon E, Jalava L, Wager O. C-reactive protein in bacterial meningitis. Ann Med Exp Fenn 1959, 37: 371-373
  9. Stearman M, Southgate HJ. The use of cytokine and C-reactive protein measure-ments in cerebrospinal fluid during acute infective meningitis. Ann Clin Biochem.1994 May; 31 (Pt 3):255-61.
  10. Tankhiwale S S, Jagtap P M, Khadse R K, Jalgaonkar S V. Bacteriological study of pyogenic meningitis with special reference to C-reactive protein. Indian J Med Microbiol 2001;19:159-60
  11. Goran Rajs, Zvezdana Finzi-Yeheskel, Andrea Rajs, Michael MayerC-Reactive Protein Concentrations in Cerebral Spinal Fluid in Gram-positive and Gram-negative Bacterial Meningitis. 2002. Clinical chemistry 48:591-592.
  12. Clause et al of Denmark. CRP in CSF. Dan. Med. Bull.1962; 9.
  13. Vaishnavi C, Dhand UK, Dhand R, Agnihotri N, Ganguly NK. C-reactive proteins, immunoglobulin profile and mycobacterial antigens in cerebrospinal fluid of patients with pyogenic and tuberculous meningitis. J Hyg Epidemiol Microbiol Immunol.1992; 36(3):317-25.
  14. Ribera E, Martinez-Vazquez JM, Ocaña I, Segura RM, Pascual C. Activity of adenosine deaminase in cerebrospinal fluid for the diagnosis and follow-up of tuberculous meningitis in adults. J Infect Dis.1987 Apr; 155(4):603-7.
  15. Malan C, Donald PR, Golden M, Taljaard JJ. Adenosine deaminase levels in cerebrospinal fluid in the diagnosis of tuberculous meningitis. J Trop Med Hyg.1984 Feb; 87(1):33-40.
  16. Mishra OP, Loiwal V, Ali Z, Nath G, Chandra L. Cerebrospinal fluid adenosine deaminase activity for the diagnosis of tuberculous meningitis in children. J Trop Pediatr.1996 Jun; 42(3):129-32.
  17. Eintracht S, Silber E, Sonnenberg P, Koornhof HJ, Saffer D. Analysis of adenosine deaminase isoenzyme-2 (ADA(2)) in cerebrospinal fluid in the diagnosis of tuberculosis meningitis. J Neurol Neurosurg Psychiatry.2000 Jul; 69(1):137-8.
  18. Gambhir IS, Mehta M, Singh DS, Khanna HD. Evaluation of CSF-adenosine deaminase activity in tubercular meningitis. J Assoc Physicians India. 1999 Feb; 47(2):192-4.

Corresponding Author

Dr Indranil Sen

HB-8/2, Sector-3, Salt Lake Kolkata Pin-700106

Phone number: 8902725184, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.