calca-protein--human and Meningitis--Aseptic

Procalcitonin (PCT) is a new indicator of the systemic response to severe infections. To evaluate clinical usefulness of serum procalcitonin measurements in the differential diagnosis of purulent versus aseptic meningitis in children was the aim of the study. Fifteen children (aged 1 month-14 years) with purulent meningitis and 12 children (aged 6 months-12 years) with aseptic meningitis were included into the study. Serum PCT concentration was measured on admission by immunoluminometric assay. Thirty healthy controls (aged 3 months-14 years) were also enrolled into the study. Serum PCT concentration was above 0.5 ng/ml in 14 out of 15 children with purulent meningitis (range 0.0-95.2 ng/ml; arrhythmetic mean--28.2 ng/ml). In all children with aseptic meningitis (range 0.0-0.3 ng/ml; mean--0.1 ng/ml) as well as in healthy controls (range 0.0-0.3 ng/ml; mean--0.1 ng/ml) serum PCT was below 0.5 ng/ml.. Elevated serum PCT concentration in child with meningitis suggests bacterial aetiology.

Topics: Adolescent; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cerebrospinal Fluid; Child; Child, Preschool; Diagnosis, Differential; Humans; Infant; Meningitis, Aseptic; Meningitis, Bacterial; Protein Precursors

Distinguishing between post-neurosurgical bacterial meningitis (PNBM) and aseptic meningitis is difficult. This study aims to evaluate the combined diagnostic value of CSF procalcitonin and lactate as novel PNBM markers in hospitalized post-neurosurgery patients.. This study was performed using CSF samples, collected by lumbar puncture, from 178 PNBM-suspected patients enrolled in a retrospective clinical study. The levels of CSF procalcitonin and lactate were appropriately assayed and the combined diagnostic value of these markers was assessed using receiver operating characteristic (ROC) curves, a two by two table, and non-parametric tests.. Fifty of the 178 patients were diagnosed with PNBM, based on the clinical symptoms and laboratory results. These PNBM patients showed significantly elevated levels of CSF procalcitonin and CSF lactate compared with the non-PNBM group (p<0.001 for both). It was revealed that the cut-off values for the diagnosis of PNBM were: 0.075ng/mL (sensitivity, 68%; specificity, 73%) for procalcitonin and 3.45mmol/L (sensitivity, 90%; specificity, 85%) for lactate. A serial test combining the levels of these two markers showed decreased sensitivity (64%) and increased specificity (91%), compared with either marker alone. In contrast, a parallel test combining the levels of these both markers showed increased sensitivity (96%) and decreased specificity (65%), compared with either marker alone.. Our study shows that the combined use of CSF procalcitonin and lactate can reliably distinguish between PNBM and non-PNBM and can be included in the design of diagnostic approaches to circumvent the shortcomings of conventional methods.

Topics: Adolescent; Adult; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Lactic Acid; Male; Meningitis, Aseptic; Meningitis, Bacterial; Middle Aged; Neurosurgical Procedures; Protein Precursors; ROC Curve; Young Adult

The objective of the present study was to determine whether selective inflammatory cytokine concentrations within cerebrospinal fluid are useful markers for the differential diagnosis of aseptic and bacterial meningitis within neurosurgical patients.. Prospective, open-label, observational, cohort study.. Neurosurgical ICU, Chang Gung Memorial Hospital.. Thirty-two consecutive neurosurgical patients who had postoperative fever following external ventricular drain insertion for the treatment of brain injury underwent serial cerebrospinal fluid cytokine analysis pre and post fever to determine the value of such markers in ascertaining the differential diagnosis of meningitis.. Cerebrospinal fluid samples were collected on the day of fever onset, as well as on day 2 and 4 pre and post fever development. Tumor necrosis factor-α, interleukin-1β, interleukin-6, interleukin-8, transforming growth factor-β, and procalcitonin were subsequently analyzed using enzyme-linked immunosorbent assay analysis techniques.. Inflammatory marker levels were compared among febrile aseptic, bacterial, and nonmeningitis patients to determine cerebrospinal fluid inflammatory changes over time. Significant increases in cerebrospinal fluid tumor necrosis factor -α, interleukin-1β, interleukin-6, and interleukin-8 levels were observed within patients with bacterial meningitis at fever onset, which was not evident in aseptic or nonmeningitis patients. Furthermore, significant increases in cerebrospinal fluid tumor necrosis factor-α, interleukin-1β, interleukin-6, and interleukin-8 levels were detected as early as 4 days prior to fever onset within patients with bacterial meningitis when compared with both aseptic and nonmeningitis groups. Interestingly, procalcitonin was only significantly increased in patients with bacterial meningitis on the fourth day post fever.. The present study suggests that raised cerebrospinal fluid tumor necrosis factor -α, interleukin-1β, and interleukin-8 in a temporal manner may indicate early bacterial meningitis development in neurosurgical patients, enabling earlier diagnostic certainty and improved patient outcomes.

Topics: Adult; Aged; Area Under Curve; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Cytokines; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Female; Fever; Humans; Inflammation Mediators; Interleukin-6; Interleukin-8; Male; Meningitis, Aseptic; Meningitis, Bacterial; Middle Aged; Neurosurgical Procedures; Postoperative Complications; Prognosis; Prospective Studies; Protein Precursors; Risk Assessment; ROC Curve; Survival Rate; Tumor Necrosis Factor-alpha

To evaluate the role of serum procalcitonin (PCT) in diagnosis of septic meningitis in children and its efficacy in differential diagnosis.. The study included 40 children of septic meningitis admitted in pediatric ward with fever, headache, vomiting and seizure, up to 14 y of age. The diagnosis of septic meningitis was based on clinical features; physical examination, blood and cerebrospinal fluid (CSF) cytochemical findings, gram's stain and bacterial culture. Fifteen cases of aseptic meningitis admitted during same period were also included in the study, and 15 children with normal CSF were taken as control. Serum PCT was measured by ELISA Kit.. Serum PCT level was significantly higher in children with septic meningitis than those with aseptic meningitis or in controls (p < 0.001). In culture and gram's stain positive 7 cases, serum procalcitonin was significantly elevated (24,768.21 ± 6,567.45 pg/mL) than aseptic meningitis(14,451.24 ± 4,266.15 pg/mL) (p < 0.001). Further its level was found significantly elevated in partially treated septic meningitis as compared to aseptic meningitis cases (p < 0.001). At optimum cut off value of ≥ 5,000 pg/mL, based on area under ROC curve, PCT showed sensitivity, specificity, positive predictive value and negative predictive value of 98.5 %, 93.5 %, 98.6 % and 93.3 % respectively. Serum PCT with cut off level of 15,000 pg/ml showed sensitivity, specificity, PPV and NPV of 92 %, 67 %, 91.4 % and 71.4 % respectively for the differentiation of septic from aseptic meningitis.. Serum PCT may be used as diagnostic marker for septic meningitis and its differentiation from aseptic meningitis.

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Cross-Sectional Studies; Diagnosis, Differential; Early Diagnosis; Female; Gentian Violet; Humans; India; Male; Meningitis, Aseptic; Meningitis, Bacterial; Phenazines; Predictive Value of Tests; Protein Precursors; ROC Curve

To determine the level of serum procalcitonin, blood leukocyte count (TLC) and C-reactive protein (CRP) in children with bacterial and non bacterial meningitis and document their efficacy in differential diagnosis. Also described are procalcitonin levels variation during treatment.. From March 2005 to February 2008, we evaluated 38 clinically suspected meningitis patients in the paediatric departments, Al-Jedaany Hospital, Jeddah, KSA, for Serum procalcitonin, CRP, TLC and Lumbar punctures and CSF analysis. Patients were classified into bacterial meningitis group I (18) and non bacterial meningitis group II (20).. Serum PCT levels were significantly higher in bacterial meningitis (BM) {mean 4.8 +/- 3.85 ng/ml (2.9-11.6)} compared with non bacterial meningitis (NBM) {mean 0.38 +/- 0.25 ng/ml (0.31-0.61)} {P < 0.001}. Mean of all CSF parameters, TLC {15,000 +/- 2,900 cell/ml(BM) & 9500 +/- 1105 cell/ml (NBM)} and CRP {20 +/- 6.8 mg/l (BM) & 12.5 +/- 12.0 mg/l (NBM)} showed a zone of overlapping between the two groups. There is a positive correlation between serum PCT, TLC and CRP in bacterial and non bacterial meningitis cases but this relation becomes highly significant with bacterial meningitis positive group. Day 3 and day 6 treatment serum PCT was less than on admission levels (P < 0.001).. PCT can be used in the early diagnosis of bacterial meningitis and may be a useful adjunct in differentiating bacterial and non bacterial meningitis than CRP or TLC and diminishing the value of lumbar puncture performed 48-72 hours after admission to assess treatment efficacy.

Topics: Anti-Bacterial Agents; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cerebrospinal Fluid; Child; Child, Preschool; Diagnosis, Differential; Female; Follow-Up Studies; Hospitals, Teaching; Humans; Infant; Leukocyte Count; Male; Meningitis, Aseptic; Meningitis, Bacterial; Predictive Value of Tests; Protein Precursors; Spinal Puncture

To validate procalcitonin (PCT) level as the best biological marker to distinguish between bacterial and aseptic meningitis in children in the emergency department.. Secondary analysis of retrospective multicenter hospital-based cohort studies.. Six pediatric emergency or intensive care units of tertiary care centers in 5 European countries.. Consecutive children aged 29 days to 18 years with acute meningitis.. Univariate analysis and meta-analysis to compare the performance of blood parameters (PCT level, C-reactive protein level, white blood cell count, and neutrophil count) and cerebrospinal fluid parameters (protein level, glucose level, white blood cell count, and neutrophil count) quickly available in the emergency department to distinguish early on between bacterial and aseptic meningitis.. Of 198 patients analyzed, 96 had bacterial meningitis. Sensitivity of cerebrospinal fluid Gram staining was 75%. The PCT level had significantly better results than the other markers for area under the receiver operating characteristic curve (0.98; 95% confidence interval, 0.95-0.99; P = .001). At a 0.5-ng/mL threshold, PCT level had 99% sensitivity (95% confidence interval, 97%-100%) and 83% specificity (95% confidence interval, 76%-90%) for distinguishing between bacterial and aseptic meningitis. The diagnostic odds ratio between high PCT level and bacterial meningitis was 139 (95% confidence interval, 39-498), without significant heterogeneity between centers.. The PCT level is a strong predictor for distinguishing between bacterial and aseptic meningitis in children in the emergency department. Its combination with other parameters in an effective clinical decision rule could be helpful.

Topics: Acute Disease; Adolescent; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Confidence Intervals; Diagnosis, Differential; Europe; Female; Follow-Up Studies; Glycoproteins; Humans; Incidence; Infant; Infant, Newborn; Male; Meningitis, Aseptic; Meningitis, Bacterial; Odds Ratio; Protein Precursors; Retrospective Studies; ROC Curve

To refine and to re-validate the best current tool (the Nigrovic rule: ''outpatient management may be considered for children without seizure, blood neutrophil count>or=10,000/mm(3), positive cerebrospinal fluid -CSF- Gram-staining, CSF protein>or=80 mg/dl, or CSF neutrophil count>or=1,000/mm(3)'') proposed to distinguish between aseptic meningitis (AM) and bacterial meningitis (BM) in the emergency department.. Children hospitalized for BM between 1995 and 2004, or AM between 2000 and 2004 were included, and randomly divided into derivation (111 children, 14 BM) and internal validation (57 children, 7 BM) sets. The Nigrovic rule was refined on the derivation set, introducing new variables (purpura, toxic appearance and high serum procalcitonin), changing variables thresholds (CSF protein) and withdrawing some variables (blood neutrophil count, CSF neutrophil count), according to previous results, with the aim to obtain 100% sensitivity user friendly tool. The refined rule was then applied on the internal validation set, stayed blinded during the derivation process.. The refined rule was: start antibiotics in case of seizure, purpura, toxic appearance, procalcitonin>or=0.5 ng/ml, positive CSF Gram-staining, or CSF protein>or=50 mg/dl. The refined rule had 100% sensitivity on the derivation and the internal validation sets (95% confidence interval 78-100, and 65-100, respectively) with 62 and 51% specificity, respectively.. The refined rule (called Meningitest) was a highly sensitive, specific and user friendly tool that could allow to safely avoid>50% a posteriori unuseful antibiotic treatments for patients with AM.

Topics: Adolescent; Calcitonin; Calcitonin Gene-Related Peptide; Cerebrospinal Fluid Proteins; Child; Child, Preschool; Decision Support Techniques; Female; Hospitalization; Humans; IgA Vasculitis; Infant; Infant, Newborn; Male; Meningitis, Aseptic; Meningitis, Bacterial; Neutrophils; Protein Precursors; Retrospective Studies; Seizures; Sensitivity and Specificity

To identify the biologic tests that best distinguish between bacterial and aseptic meningitis in an emergency department (ED).. All children hospitalized for bacterial meningitis between 1995 and 2004 or for aseptic meningitis between 2000 and 2004 were included in a retrospective cohort study. Predictive values of blood (C-reactive protein, procalcitonin [PCT], white blood cell [WBC] count, neutrophil count) and cerebrospinal fluid (CSF) findings (protein, glucose, WBC count, neutrophil count) available in the ED were determined. Tests with the best predictive value were identified by using univariate and multivariate analyses and ROC curves comparison.. Among the 167 patients included, 21 had bacterial meningitis. The CSF gram-stain and bacterial antigen test had 86% and 60% sensitivity rates, respectively. PCT (>/=0.5 ng/mL) and CSF protein (>/=0.5 g/L) were the best biologic tests, with 89% and 86% sensitivity rates, 89% and 78% specificity rates, adjusted odds ratios of 108 (95% CI, 15-772) and 34 (95% CI, 5-217), and areas under the ROC curves of 0.95 and 0.93, respectively.. PCT and CSF protein had the best predictive value to distinguish between bacterial and aseptic meningitis in children.

Topics: Adolescent; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cerebrospinal Fluid Proteins; Child; Child, Preschool; Cohort Studies; Diagnosis, Differential; Female; Glucose; Humans; Infant; Leukocyte Count; Male; Meningitis, Aseptic; Meningitis, Bacterial; Neutrophils; Protein Precursors; Retrospective Studies; ROC Curve; Sensitivity and Specificity

Symptomatic aseptic, chemical meningitis is a rare complication of myelography. Its acute clinical course and standard laboratory findings are indistinguishable from those of bacterial meningitis. The authors present a case of severe postmyelographic chemical meningitis and compare CSF and serum inflammatory markers to a group of seven patients with proven bacterial meningitis. As in viral meningitis, procalcitonin might be able to discriminate between bacterial and chemical causes of CNS inflammation.

Topics: Adult; Aged; Biomarkers; Brain Edema; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Contrast Media; Diagnosis, Differential; Female; Glucose; Humans; Hydrocephalus; Leukocyte Count; Male; Meningitis, Aseptic; Meningitis, Bacterial; Middle Aged; Myelography; Protein Precursors; Time Factors; Triiodobenzoic Acids