Keywords
C-reactive protein
meningitis
pediatrics
How to Cite
Abstract
Introduction: Meningitis is an infection of the central nervous system, which, in 80% of the cases, occurs in childhood. Due to its association with high morbimortality, it is considered an infectological emergency. The main etiologies are viral and bacterial. The chemical and cytological analysis of cerebrospinal fluid is key to orient the etiological diagnosis and provide proper treatment. There is evidence that serum C-reactive protein could contribute. Objective: To analyze the utility of cerebrospinal fluid parameters and C-reactive protein in the discrimination of viral and bacterial meningitis in pediatric patients. Materials and methods: The study was observational, analytical, cross-sectional and retrospective. Clinical records of children with diagnosis of meningitis with confirmed etiological agent assessed from January 2016 to December 2019 in the General de Niños Pedro de Elizalde Hospital (Buenos Aires, Argentina) were revised. Results: A total of 101 records were included. Total proteins, cell counts and C-reactive protein were significantly higher in patients with bacterial meningitis, whereas glucose was lower. No difference was found in lactate level. In establishing bacterial etiology, serum C-reactive protein level above 34.77 mg/L showed a sensitivity of 100%, a specificity of 92% and a negative predictive value of 100%; for total proteins, a cut-off point of 0.52 g/L showed the best sensitivity, while for glucose a cut-off point of 55 mg/ dL had the highest specificity. Conclusion: Cerebrospinal fluid protein and glucose levels were the best parameters to discriminate between these etiologies. Serum C-reactive protein showed very good performance, although further studies in pediatric patients are needed to establish its utility.
References
1. Dondoglio P, García-Pítaro L, Potasznik J, Saenz C, Vinellli N. Meningitis. Rev Pediatr Elizalde. 2018;9(1):51-54, https://www.apelizalde.org/revistas/2018-1-ARTICULOS/RE_2018_1_PP_6.pdf
2. Baquero F, Vecino R, Del Castillo F. Meningitis bacteriana. An Esp Pediatr. 2011;(6):47-57.
3. Chaudhary S, Bhatta NK, Lamsal M, Chaudhari RK, Khanal B. Serum Procalcitonin in bacterial & non-bacterial meningitis in children. BMC Pediatr. 2018;18(1):10-14, https://doi.org/10.1186/s12887-018-1314-5 4. Srinivasan L, Kilpatrick L, Shah SS, Abbasi S, Harris MC. Elevations of novel cytokines in bacterial meningitis in infants. PLoSOne. 2018;13(2):1-11, https://doi.org/10.1371/journal.pone.0181449
5. Boletín Integrado de Vigilancia. Dirección Nacional de Epidemiología Ampliado N°477 SE 50/2019. Ministerio de Salud Presidencia de la Nación. [Internet]. 2019. [Consultado 01 dic 2021]. Disponible en: https://www.argentina.gob.ar/sites/default/files/201912-biv_477.pdf
6. Kandil M, Khalil G, El-Attar E, Shehata G, Hassan S. Accuracy of heparin binding protein: as a new marker in prediction of acute bacterial meningitis. Braz J Microbiol. 2018;49 Suppl 1(Suppl 1): 213-219, https://doi.org/10.1016/j.bjm.2018.05.007
7. Muñoz AB, Hadley S, Sanz MI, Quijano TA, Camprubí MC. Role of beta-2-microglobulin as a biomarker in very preterm and extremely preterm
infants with CNS inflammation. PLoSOne. 2019;14(5): e0216498, https://doi.org/10.1371/journal.pone.0216498
8. Javadinia S, Tabasi M, Naghdalipour M, Atefi N, Asgarian R, Khezerloo J et al. C-reactive protein of cerebrospinal fluid, as a sensitive approach for diagnosis of neonatal meningitis. Afr Health Sci. 2019;19(3):2372-2377, https://doi.org/10.4314/ahs.v19i3.10
9. D´Isa G, Iñiguez M, Fernández S, López A, Quattrocchi G. Recomendaciones sobre el análisis y procesamiento de LCR. Sociedad Argentina de Terapia Intensiva. [Internet]. 2019. [Consultado 10 ene 2023].
Disponible en: https://www.sati.org.ar/images/capitulo/CapituloBioquimico/Recomendaciones_LCR_SATI.pdf
10. Reshi Z, Nazir M, Wani W, Malik M, Iqbad J, Wajud S. Cerebrospinal fluid procalcitonin as a biomarker of bacterial meningitis in neonates. J. Perinatol. 2017;37(8):927-931, https://doi.org/10.1038/jp.2017.73
11. Dubos F, Moulin F, Gajdos V, et al. Serum procalcitonin and other biologic markers to distinguish between bacterial and aseptic meningitis. J Pediatr. 2006;149(1):72-76, https://doi.org/10.1016/j.jpeds.2006.02.034
12. Montero-Reguera R. Interpretación del líquido cefalorraquídeo. An Pediatr Contin. 2014;12(1):30-33, https://www.elsevier.es/es-revistaanales-pediatria-continuada-51-articulo-interpretacion-del-liquidocefalorraquideo-S1696281814701647
13. Águeda S, Campos T, Maia A. Prediction of bacterial meningitis based on cerebrospinal fluid pleocytosis in children. Braz J Infect Dis. 2013;17(4):401-404, https://doi.org/10.1016/j.bjid.2012.12.002
14. Sanaei-Dashti A, Alizadeh S, Karimi A, Khalifeh M, Shoja S. A. Diagnostic value of lactate, procalcitonin, ferritin, serum-C-reactive protein, and other biomarkers in bacterial and viral meningitis. Medicine Baltimore. 2017;96:(35):e7637, https://doi.org/10.1097/md.0000000000007637
15. Nazir M, Wani WA, Malik MA, Mir MR, Ashraf Y, Kawoosa K, et al. Cerebrospinal fluid lactate: a differential biomarker for bacterial and viral meningitis in children. J Pediatr (Rio J). 2018;94(1),88-92, https://doi.org/10.1016/j.jped.2017.03.007
16. Javadinia, S. et al. C-reactive protein of cerebrospinal fluid, as a sensitive approach for diagnosis of neonatal meningitis. Afr Health Sci. 2019;19(3):2372-2377, https://doi.org/10.4314/ahs.v19i3.10