Optimization of a diagnostic procedure for children with preliminary diagnosis of “meningitis”

Abstract

All over the world, meningitis remains one of the most widespread neuroinfections for adults and children. Successful initiation of treatment and prognosis depends on rapid diagnosis. Diagnosis begins with a clear differentiation between bacterial and viral characteristics of the causative agent. The aim of our research was to optimize the diagnostic procedure used in Russian infectious diseases hospitals for children with preliminary diagnosis of "meningitis". There were 232 patients (1 to 14 years of age) hospitalized and observed in our Saratov State children infectious hospital with preliminary diagnosis of “meningitis.” Diagnoses occurred on day 2.2 ± 0.7 from onset of illness., It was impossible to differentiate bacterial or viral etiology of meningitis on the basis of clinical observation or results of common laboratory assays (mixed pleocytosis in analysis) cerebrospinal fluid (CSF). The results of our research of these “acute phase of inflammation proteins” demonstrate that patients with bacterial meningitis have serum C-reactive protein (CRP) levels higher than 24 mg/L (42.2 ± 5.1 mg/L, normal 0 mg/L), liquor CSF lactoferrin content – higher than 135.0 ng/L (342.6 ± 14.2 ng/L; normal 6.39 ± 1.7 ng/L), serum procalcitonin (PCT) level – higher than 0.5 ng/mL. Patients with “viral meningitis” have serum CRP levels lower than 18.0 mg/L (9.8 ± 1.1 mg/L, normal 0 mg/L), liquor CSF lactoferrin content – lower than 120.0 ng/L (61.9 ± 7.8 ng/L, normal 6.39 ± 1.7 ng/L), serum PCT level – lower than 0.5 ng/mL. For patients with “intermediate level” of CRP in their serum samples (18.0–24.0 mg/L) or lactoferrin in their CSF samples (120.0–135.0 ng/L) test on serum PCT content is highly recommended because in all cases gives unambiguous results.

Keywords

Meningitis - enterovirus - coxsackieviruses - echoviruses - children