Utility of Cerebrospinal Fluid and Serum Procalcitonin for the Diagnosis of Neonatal Meningitis

Abstract

Objective Positive CSF culture is the gold standard for the diagnosis of meningitis but it carries poor sensitivity. CSF procalcitonin (PCT) is shown to have some utility for the diagnosis of meningitis though there are limited studies in neonatal age group. We planned this study to compare CSF, serum, and CSF to serum PCT levels in neonates with confirmed, probable, and nonmeningitis groups to determine its optimal cut-off in CSF and serum for diagnosing meningitis.

Study Design Sixty-seven neonates who qualified for lumbar puncture were enrolled in the study. Neonates were categorized into confirmed meningitis, i.e., CSF cytochemistry and culture positive (N = 17), probable meningitis, i.e., CSF cytochemistry positive but culture negative (N = 25) and nonmeningitis, i.e., both cytochemistry and culture negative (N = 25). CSF and serum samples were stored at −80°C for PCT assay.

Results Significant difference was seen in mean of CSF PCT in neonates with confirmed (0.31 ng/mL), probable (0.22 ng/mL), and nonmeningitis (0.11 ng/mL) groups. Similarly, significant difference was observed in serum PCT levels also, though the ratio of serum to CSF PCT was comparable. At cut-off of 0.2 ng/mL, CSF PCT had sensitivity of 95.2% and specificity of 96% in the diagnosis of meningitis.

Conclusion CSF PCT is more specific marker for the diagnosis of neonatal meningitis as compared with serum PCT and CSF to serum PCT ratio.

Key Points

• CSF procalcitonin is a better marker than serum procalcitonin for diagnosing neonatal meningitis.

• It is better than serum procalcitonin and CSF to serum procalcitonin ratio.

• At cut-off of >0.2 ng/mL CSF procalcitonin can diagnose neonatal meningitis with 96% specificity.

Keywords

procalcitonin - neonatal meningitis - cerebrospinal fluid - serum

Publikationsverlauf

Eingereicht: 06. Mai 2020

Angenommen: 30. Juli 2020

Artikel online veröffentlicht:
13. September 2020

• References

• 1 Grandgirard D, Leib SL. Meningitis in neonates: bench to bedside. Clin Perinatol 2010; 37 (03) 655-676
• 2 Furyk JS, Swann O, Molyneux E. Systematic review: neonatal meningitis in the developing world. Trop Med Int Health 2011; 16 (06) 672-679
• 3 National Neonatal-Perinatal Database. Report of the National Neonatal Perinatal Database (National Neonatology Forum), 2002–2003; 2020. Accessed April 22, 2004 at: http://www.newbornwhocc.org/pdf/nnpd_report_2002–03.PDF
• 4 de Louvois J, Halket S, Harvey D. Neonatal meningitis in England and Wales: sequelae at 5 years of age. Eur J Pediatr 2005; 164 (12) 730-734
• 5 Levent F, Baker CJ, Rench MA, Edwards MS. Early outcomes of group B streptococcal meningitis in the 21st century. Pediatr Infect Dis J 2010; 29 (11) 1009-1012
• 6 Garges HP, Moody MA, Cotten CM. et al. Neonatal meningitis: what is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters?. Pediatrics 2006; 117 (04) 1094-1100
• 7 Huang H, Tan J, Gong X. et al. Comparing single vs. combined cerebrospinal fluid parameters for diagnosing full-term neonatal bacterial meningitis. Front Neurol 2019; 10: 12
• 8 Chiba N, Murayama SY, Morozumi M. et al. Rapid detection of eight causative pathogens for the diagnosis of bacterial meningitis by real-time PCR. J Infect Chemother 2009; 15 (02) 92-98
• 9 K M, Batra P, Faridi MMA, Singh NP. K M. Procalcitonin as predictor of bacterial infection in meconium aspiration syndrome. Am J Perinatol 2018; 35 (08) 769-773
• 10 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 (01) 72-76
• 11 Batra P, Dwivedi AK, Thakur N. Bedside ABG, electrolytes, lactate and procalcitonin in emergency pediatrics. Int J Crit Illn Inj Sci 2014; 4 (03) 247-252
• 12 Pontrelli G, De Crescenzo F, Buzzetti R. et al. Accuracy of serum procalcitonin for the diagnosis of sepsis in neonates and children with systemic inflammatory syndrome: a meta-analysis. BMC Infect Dis 2017; 17 (01) 302
• 13 Prasad R, Kapoor R, Mishra OP, Srivastava R, Kant Singh U. Serum procalcitonin in septic meningitis. Indian J Pediatr 2013; 80 (05) 365-370
• 14 Dubos F, Korczowski B, Aygun DA. et al. Serum procalcitonin level and other biological markers to distinguish between bacterial and aseptic meningitis in children: a European multicenter case cohort study. Arch Pediatr Adolesc Med 2008; 162 (12) 1157-1163
• 15 Jereb M, Muzlovic I, Hojker S, Strle F. Predictive value of serum and cerebrospinal fluid procalcitonin levels for the diagnosis of bacterial meningitis. Infection 2001; 29 (04) 209-212
• 16 Reshi Z, Nazir M, Wani W, Malik M, Iqbal J, Wajid S. Cerebrospinal fluid procalcitonin as a biomarker of bacterial meningitis in neonates. J Perinatol 2017; 37 (08) 927-931
• 17 Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014; 14: 135
• 18 Raddant AC, Russo AF. Reactive oxygen species induce procalcitonin expression in trigeminal ganglia glia. Headache 2014; 54 (03) 472-484
• 19 Gendrel D, Raymond J, Assicot M. et al. Measurement of procalcitonin levels in children with bacterial or viral meningitis. Clin Infect Dis 1997; 24 (06) 1240-1242
• 20 Alons IME, Verheul RJ, Kuipers I. et al. Procalcitonin in cerebrospinal fluid in meningitis: a prospective diagnostic study. Brain Behav 2016; 6 (11) e00545
• 21 Konstantinidis T, Cassimos D, Gioka T. et al. Can procalcitonin in cerebrospinal fluid be a diagnostic tool for meningitis?. J Clin Lab Anal 2015; 29 (03) 169-174