Title: Estimation of C-Reactive Protein (C-RP) in Serum and Cerebrospinal Fluid (CSF) to Differentiate between Pyogenic and Tubercular Meningitis
Authors: Dr Manoj Kumar, Dr Tejpal Singh, Dr Awadhesh Yadav, Dr Kushal Pal
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.166
Abstract
Meningitis is one of the commonest and most feared neurological disease in children and adults with high morbidity and mortality. So, this study was conducted to measure the serum and CSF C-reactive protein to differentiate between pyogenic and tubercular meningitis.
Method: This study was conducted in Department of Medicine, S. N. Medical College, Agra. Adult between 12 - 50 years of age admitted with history of fever and seizure were included. CSF was sent for CRP estimation and other laboratory investigations. Patients were divided into three groups based on clinical and CSF finding. Group 1 (Bacterial Meningitis), Group 2 (Tubercular Meningitis) and Group 3 (Control Group). Statistically analysis was done by Chi-square test and Student “t” test.
Result: 60 patients were enrolled in our study. The mean ages of our cases in pyogenic tubercular and control group was 22.38 years, 26.38 years and 28.95 years respectively. 8 cases had pyogenic meningitis, 32 cases had tubercular meningitis and 20 cases had no meningitis. Serum value of CRP in case of pyogenic meningitis which is statistically significantly raised than that in tubercular group (mean value 36.52mg/L) (p value < 0.0001). The value of mean CRF level was found to be significantly higher in the pyogenic meningitis (91.13 mg/L), compare to tubercular meningitis (2.70 mg/L) and control group (1.54 mg/L with p value <0.0001), which is statistically significant.
Conclusion: Serum CRP and CSF - CRP estimation in meningitis is good parameter to differentiate pyogenic from other meningitis.
References
- Abramson JS, Hampton KD, Babu S, Wasilauskhas BL, Macron MJ. The use of C-reactive protein in cerebrospinal fluid for differentiating meningitis from other central nervous system disease. J. Inf Dis 1985; 151: 854 - 858.
- Corral, C. J., Pepple, J.M. Moxon, R. and Hughes, W.T.: C-reactive protein in cerebrospinal fluid in children with meningitis. J. Pediatr., 99: 365-369, 1981.
- Peltola, H. O. : C-reactive protein for rapid monitoring of infections of the central nervous system. Lancet, 1: 980-982, 1982.
- Sirijaichingkul S, Tiamkao S, Sawayawisuth K, Chotmongkol V. Journal of the Medical Association of Thailand, 2005 ; 88 (9) : 1251 - 1256.
- Vaishnavi C, Dhand UK and R et al. C-reactive proteins, immunoglobulin profile and mycobacterial antigens in cerebrospinal fluid of patients with pyogenic and tubercular meningitis. J Hyg Epidemiol Microbiol Immunol 1992; 36(3): 317 - 325.
- Tankhiwale SS, Jagtap Pm, Khadse RK, Jalgaonkar SV. Bacteriological study of pyogenic meningitis with special reference of C-reactive protein. Indian J Med Microbiol 2001; 19(3) : 159 - 160.
- Gaur A and Seshan SV. CSF C-reactive protein estimation for bedside diagnosis of pyogenic meningitis. Indian Pediatr 2004; 41(10): 1073 - 1074.
- Sutinen J, Sombrero L , Paladin FJE, Julkunen I, Leinikki P, Hernandez E, Saniel M, Brato D, Ruutu P. International Journal of infectious diseases.1999;3 (2):88-93.
- Debeer, F. C., Kirster, G. F., Gie, R. P., Beyers, N. and Stachan, A. F. : Value of C-reactive protein measurement in tuberculous, bacterial and viral meningitis. Arch. Dis. Child., 59: 653 - 656, 1984.
- Pepys MB.C-reactive protein-fifty years on. Lancet1981;1:653-6.