Procalcitonin Levels in Patients with Bacterial Meningitis: A Comparison of Cerebrospinal Fluid and Blood Levels

Description

Abstract (English)

Abstract
Background: In developing countries despite advances in antibiotic therapy Bacterial
meningitis remains a significant cause of morbidity and mortality. It is commonly diagnosed
on basis of clinical presentation and cerebrospinal fluid analysis (CSF). But at times atypical
CSF findings are encountered over cases of clinically suspected bacterial meningitis and
sometimes due to prior antibiotic use, which puts the treating physician in dilemma regarding
initiation of antibiotics. Therefore, an early and a confirmed diagnosis is required for
managing such cases and to achieve a favorable outcome. Various studies suggest
Procalcitonin to be a promising biomarker for diagnosing bacterial infections. But there are
also studies which suggest serum procalcitonin and CSF procalcitonin to be a superior biomarkers in differentiating Bacterial from another non-bacterial meningitis. Therefore, this
study is undertaken to find out a biochemical marker to diagnose Bacterial meningitis with
increased accuracy which will help the clinicians to differentiate Bacterial meningitis from
other common infective meningitis, for proper therapeutic decisions with the following
objectives
Aim: A comparative study of cerebrospinal fluid Procalcitonin and serum procalcitonin in
patients with bacterial meningitis.
Material and Method: This observational and analytical study was carried out in the
Department of General Medicine, among patients admitted under Department of General
Medicine and Department of Neurology with a sample size of 60 following inclusion and
exclusion criteria. The subjects were evaluated, data collected, blood samples were sent for
routine investigations and Lumbar puncture was done in favorable subjects. The CSF analysis
was done along with serum and CSF procalcitonin. The test for CSF and Serum procalcitonin
were conducted using a Sandwich immunodetection method using ichroma PCT analyzer.
The results were analysed using appropriate statistical methods.
Results: In our study it was observed that the elderly age group has a higher association with
meningitis. The occurrence of Bacterial meningitis shows a significant seasonal pattern,
mostly during winter. Subjects of bacterial meningitis has the longest duration of hospital
stay. The predictive value of both serum and CSF procalcitonin are higher in cases of
Bacterial meningitis in comparison to non-bacterial meningitis. The ROC analysis concluded
that the diagnostic accuracy of CSF procalcitonin is slightly higher but statistically not
significant in diagnosing Bacterial meningitis. The Cerebrospinal fluid and Serum
procalcitonin were not significant in cases of Viral meningitis and Tubercular meningitis
making it a poor biomarker in this meningitis.Conclusion: Both serum and CSF procalcitonin are better markers in diagnosing Bacterial
meningitis and to differentiate them from another non-bacterial meningitis. The study was
conducted in context of high morbidity and mortality of Bacterial meningitis and associated
complications and the need for a better bio-marker in early diagnosis of Bacterial meningitis
and initiation of prompt and proper treatment. The data was analyzed and observations were
discussed along with relevant contemporary literature and other studies. Further research
works needs to be done on combined use of Serum as well as CSF procalcitonin in cases of
Bacterial meningitis.