Utility of CSF C-Reactive Protein In Differentiating Bacterial Meningitis From Aseptic Meningitis In Children 1month-12 Years of Age: Prospective Comparative Study

Abstract

Aim: The Study of CSF C-reactive protein in meningitis to differentiate bacterial
meningitis from aseptic meningitis in children between 1 month and 12 years of age.
Methods: The Prospective comparative study was conducted in the Department of
pediatrics, Vardhman institute of medical sciences, Pawapuri, Nalanda, Bihar, India, for
15 months. 130 children between 1 month to 12 years of age admitted with acute
history of fever and seizure were included in the study. Patients were divided into 3
groups based on clinical and CSF findings. Group 1 (Bacterial meningitis) was defined
by a CSF leukocyte count of 100–10,000/mm 3 with polymorphonuclear neutrophils
(PMNs) of >50%, a CSF glucose level <2/3 blood sugar level, and a CSF protein level
of 100-500 mg/dl with bacteria isolated from CSF culture. Group 2 (Aseptic Meningitis)
was defined as those with a CSF pleocytosis of <100/mm 3 with lymphocyte
predominance, protein levels of 50-200 mg/dl, and normal glucose levels with a negative
bacterial culture and Gram stain. Group 3 (No meningitis/Control Group) included
patients with fever and convulsions but normal CSF study.
Results: During the study period 130 patients were enrolled in our study after written
informed consent was obtained. 85(65.38 % of our cases were males. The mean age of
our cases was 76.25±42.69 months. Depending on the CSF cytology, biochemistry and
bacteriology 50 cases had bacterial meningitis and were included in Group 1 , 45 cases
had Aseptic Meningitis and were included in Group 2 and 35 cases had no meningitis hence included in Group 3. CSF-CRP was positive in 36 (72%) cases of Bacterial
meningitis, 7(15.56%) cases of aseptic meningitis and negative in all cases of control
group. The Sensitivity 73.26 %, Specificity 86.87 %, Positive Predictive Value ( PPV)
85.98 %, Negative Predictive Value ( NPV)74.77% and Diagnostic Accuracy ( DA) 80.28
% of CSF-CRP for diagnosis of bacterial meningitis.
Conclusion: The CSF-CRP has a high sensitivity, specificity, NNV, PPV and diagnostic
accuracy and can be used as an initial test for the diagnosis of Bacterial Meningitis
till other confirmatory test reports are awaited.