A Prospective Study to Assess the Significance of Serum and Cerebrospinal Fluid C-Reactive Protein (CRP) Level in Meningitis in Adults and its Role differentiating Pyogenic from Non-Pyogenic Meningitis
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 1
Abstract
Introduction: Acute Pyogenic Meningitis is the most common cause of suppurative infection in the central nervous system. The prognosis of pyogenic meningitis is critically dependant on a rapid and causal implementation of immediate treatment. However, clinical and biochemical parameters are not reliable enough except when bacteria are found in the CSF under a microscope. Therefore, the treatment of acute pyogenic meningitis is most of the time presumptive. Use of biological markers, especially lymphokines and acute phase reactants has been proposed to facilitate the initial diagnosis. Today C-reactive protein is one of the most widely used inflammatory markers in the emergency department to distinguish bacterial from non-bacterial infections. Aims and Objectives: To evaluate the utility of C- reactive protein levels in serum and CSF as rapid screening test in meningitis patient to differentiate pyogenic and non-pyogenic meningitis. Materials and Methods: Source of Data: Patients who were admitted in the general medicine wards and intensive medical care unit in the Department of General medicine, Government Thiruvannamalai Medical College Hospital, for the complaints suggestive of meningitis such as fever, headache, neck stiffness, seizures, vomiting, altered sensorium, signs of meningeal irritation and focal neurologic deficits regardless of their past treatment status with the fulfilment of the inclusion and exclusion criteria included in the study. Sample Size: 50 patients admitted to our Department of General medicine, Government Thiruvannamalai Medical College Hospital, with clinical syndrome suggestive of Acute meningitis such as fever, headache, neck stiffness, seizures, vomiting, altered sensorium, signs of meningism and focal neurologic deficit regardless of their past treatment status are enrolled in our study. Informed consent was obtained from the patients or the attenders if the patient is sick enough to give the consent. Study Design: Prospective and observational study Study Duration: 6 months Statistical Methods: Following statistical methods have been employed in the present study • Independent sample‘t’ test - Unpaired • One-way analysis of variance (ANOVA) • Fischer’s exact test Conclusion: 1. The Cerebrospinal fluid level of CRP is elevated in acute pyogenic meningitis and hence it is useful to differentiate it from viral meningitis/encephalitis. 2. Therefore, the CRP assays in Cerebrospinal fluid is highly useful in the management aspects whenever the diagnosis is uncertain by conventional methods. 3. The Cerebrospinal fluid level of CRP is significantly elevated in patients who expired and in patients with post meningitis sequelae than in patients recovered uneventfully. So, it may be used as a marker of prognostication in acute pyogenic meningitis. 4. The Cerebrospinal fluid level of Lactate is significantly elevated in patients who expired than in patients with post meningitis sequelae and is even lower in patients who recovered uneventfully. Hence it predicts the clinical outcome better and it can be used as a marker of prognostication in acute pyogenic meningitis.
Authors and Affiliations
Dr. V. Subramanian, Dr. S. Siva kumar, Dr. V. Senthil kumar
Keywords
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- EP ID EP434298
- DOI 10.9790/0853-1801074862.
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