Role of Procalcitonin in Diagnosis of Meningitis
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- Category: Vol. 85, December 2017
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Role of Procalcitonin in Diagnosis of Meningitis, ENTESAR H. EL-SHARQAWY, HANY R. ELKHOLY, AZZA A. ABO-SENNA and WALAA M. SHARAF
Abstract
Background: Meningitis is a significant cause of morbidity and mortality worldwide. Cerebrospinal Fluid (CSF) analysis is the current gold standard for diagnosis. However, this test does not achieve a high enough sensitivity and specificity to distinguish between bacterial and viral meningitis. So, an urgent need for rapid diagnosis with a higher sensitivity is recommended.
Aim of the Work: To assess clinіcal usefulness of CSF PCT in diagnosis of septic versus aseptic meningitis.
Subjects and Methods: This study was conducted after formal consent on 60 patients (pts) presented with a picture of meningitis. They were divided into: Group I (GI) (30pts with bacterial meningitis), GII (30рts with viral meningitis) and GIII controls: 30pts undergoing spinal anesthesia for non-neurological operations.
Results: CSF Icucocytes and PMN% were higher in bacterial than viral group. Also protein content was higher, while sugar was lower in bacterial versus viral group. The most common pathogen causing bacterial meningitis according to culture was S. pneumonae (36.7%), Meningococci (23.3%) and H. influenza (10.0%). The least common pathogens were Staph (3.3%) & E-coli (3.3) and culture was negative in (23.3%). CSF procalcitonin level was significantly higher in bacterial meningitis than viral meningitis with a mean value 384.1 versus 281.1 (pg/ml) with p=0.006. Both meningitis groups had also significantly higher levels of PCT than the controls (186.6 pg/ml) with p<0.001. ROC curve showed that CSF PCT at level ?216.74pg/nil is diagnostic of meningitis with sensitivity of 83.3%, specificity 66.7%, Positive Predictive Value (PPV) 833% and Negative Predictive Value (NPV) 66.7% and AUC (0.83). At level ?295.4pg/ml PCT is diagnostic for bacterial meningitis with sensitivity 76.7%, specificity 68.3%, PPV 71.8%, NPV 75% and AUC 0.8. At level <295.4 pg/m1 PCT is diagnostic for viral meningitis with sensitivity (73.3%), specificity (63.3%), PPV (66.7%) NPV (70.4%) and AUC (0.7).