Serum Procalcitonin Level and Other Biological Markers to Distinguish Between Bacterial and Viral Meningitis in Children

Abstract

Despite the advances in diagnosis and treatment of infectious diseases, meningitis and encephalitis are still considered as important causes of mortality and morbidity.

Distinguishingbetween bacterial and aseptic meningitis in the emergency room (ER) is sometimes difficult and classic biological markers inblood (C-reactive protein level, white blood cell count, and neutrophil count) or CSF (protein level, glucoselevel, WBC count, and neutrophil count) used alonedo not offer 100% sensitivity with high specificity for distinguishingbetween bacterial and aseptic meningitis.

Serum procalcitonin (PCT) levelseems to be one of the mostsensitive and specific predictors for discriminating betweenbacterialand aseptic infections.

procalcitoninis a protein produced by the C cells of the thyroid gland as a precursor protein of calcitonin. The origin of the synthesis and secretion of PCT during infections are considered to be extra-thyroidal because it has been possible to demonstrate its production in the lung, liver, pancreas, colon, and other organs. procalcitoninbehaves like an acute phase protein, the production of which is increased by inflammatory stimuli, including infections.

This study was thus designed to evaluate the ability of procalcitoninto differentiate between bacterial and viral meningitis in children. In this study, the 60 studied childrenwere divided into two groups. The first group included 50 patients who were diagnosed as meningitis according to CSF cytological, bacteriological and biochemical findings and or culture recruited. This group was subdivided into 2 subgroups. Subgroup (A) included 26 patients with bacterial meningitis and subgroup (B) included 24 patients with viral meningitis.The second group included 10 children who were apparently healthy served as a control group. For all patients included in the study the following was done: I-Full clinical assessment including: 1. Complete history taking laying stress on the presence or absence of fever, headache, vomiting, refusal of feeding, movement disorders, impairment of consciousness and history of antibiotic intake. 2. Complete physical examination laying stress on temperature, presence or absence of skin rash, chest, cardiac and abdominal examination. 3. Complete neurological examination with particular stress on level of consciousness, signs of meningeal irritation e.g. nuchal rigidity, Brudziniski’s and kerning’s signs, bulging anterior fontanele in infants less than 2 years of age and cranial nerve examination.

II-Laboratory investigations: A-Blood tests • Complete blood count with absolute neutrophil count • C-reactive protein • Procalcitonin measurement by ELISA B-Cerebrospinal fluid examinations • Physical examination • Chemical analysis for protein and glucose • Cytological examination • Bacteriological examination -For all controls the following blood tests were done: • Complete blood count with absolute neutrophil count • C-reactive protein • Procalcitonin measurement by ELISA From the results of clinical examination and laboratory investigations we demonstrated t