M. JOHN ET AL.
Cerebrospinal Fluid C-Reactive Protein Measurement—A Bedside Test in the Rapid Diagnosis of Bacterial Meningitis by M. John,* I. S. Raj,* R. Macaden,* T. S. Raghuveer,** M. Yeswanth,** andD. M. Meundi*** * Department of Microbiology, St. John's Medical College, Bangalore 560034, Karnataka, India ** Department of Pediatrics, St. John's Medical College Hospital, Bangalore 560034, Karnataka, India *** Department of Pediatrics, Vani Vilas Hospital, Bangalore 560002, Karnataka, India
C-reactive protein (C-RP) determinations were performed by tbe Latex agglutination method on the cerebrospinal fluid (CSF) samples of 212 patients with clinical features suggestive of meningitis. Patients were grouped as follows Group I: bacterial meningitis and partially treated bacterial meningitis (n = 22). Group II: viral encephalitis (n = 11). Group III: tuberculous meningitis (n = 18). Group IV: (i) febrile convulsions (n = 87); (ii) epileptic seizures (n = 70); (iii) intracranial haemorrhage (n = 4). C-RP was a better indicator of bacterial meningitis (sensitivity 91 per cent) than the Gram's stain (sensitivity 46 per cent). C-RP was positive in 91 per cent of patients in Group I, none in Groups II and III and 0.6 per cent in Group IV. C-RP determination in CSF proved to be a useful indicator of bacterial meningitis and served to distinguish it from viral encephalitis, tuberculous meningitis, febrile convulsions and other central nervous system disorders.
Introduction
C-Reactive protein (C-RP) is the prototype acute phase reactant. It's concentration is known to rise a thousand-fold in response to most forms of tissue damage, acute inflammation, and acute bacterial infection.1"8 The increase is rapid with prolonged elevated levels in serum and body fluids closely associated with the affected tissues.12 Hence C-RP detection in the cerebrospinal fluid (CSF) has found application as a sensitive indicator in distinguishing bacterial meningitis from other infections of the central nervous system.9"11 Although various methods for the rapid diagnosis of bacterial meningitis are available12"18 these have their limitations and may be unsuitable for use in developing countries.19 Acknowledgements The authors are grateful for the co-operation of the members of the Department of Microbiology, St. John's Medical College, and Department of Paediatrics, St. John's Medical College Hospital. The assistance given by Dr H. G. V. Rao and Mr A. S. Mohammed in the statistical analysis is gratefully acknowledged. They are also grateful for the secretarial assistance of Mrs Lakshmi Menon. Correspondence: Dr Ragini Macaden. Journal of Tropical Pediatrics
Vol.36
October 1990
This study was done to correlate CSF C-RP using a qualitative latex agglutination test9"1' with the conventional rapid diagnostic method—the Gram's stain in patients clinically diagnosed as having bacterial meningitis and partially treated bacterial meningitis, and to differentiate it from viral encephalitis, tuberculous meningitis, febrile convulsions, and other disorders of the central nervous system in a pediatric population. Materials and Methods
C-RP determination was carried out on cebrospinal fluid from 212 patients in the age group 15 days-12 years, admitted to the pediatric wards of St. John's Medical College Hospital and Vani Vilas Hospital, Bangalore, with clinical features suggestive of meningitis. The 212 patients were categorized into four groups. Group I: patients with clinical and laboratory evidence of bacterial meningitis and partially treated bacterial meningitis (n = 22; bacterial culture positive = 20; culture negative = 2). Group II: patients with clinical and laboratory evidence of encephalitis (n= 11). ) Oxford University Press 1990
213
Downloaded from http://tropej.oxfordjournals.org/ at University of Sussex on July 21, 2015
Summary
M. JOHN ET AL.
Group III: patients with clinical and laboratory evidence of tuberculous meningitis (n = 18). Group IV: patients with other CNS disorders (n = 161). (i) febrile convulsions—87; (ii) epileptic seizures—70; (iii) intracranial haemorrhage—4. CSF specimens were collected by lumbar punctures with sterile precautions and processed within 2 hours of collection as follows.
Biochemistry Estimation of glucose and protein concentration. Bacterial culture Centrifuged deposit plated on sheep blood, chocolate, MacConkey's agar, and thioglycollate medium. After 18 hours of incubation in a candle jar, the colonies were identified according to recommended methods.10
Bacterial isolates Staph. aureus H. inftutnzae S.pneumoniae E. coli Kleb. enterobacter sp. S. typhi Ps. aeruginosa No organisms Total
C-RP no.*
Grain's wtain no.*
6 2 3 3 2 1 3 2
4 2 3 3 2 1 3 2
4 1 I 1 1 1 1 0
20 (91%)
10 (46%)
22
•Numbers indicate samples of CSF positive for C-RP and showing the presence of bacteria on Gram's stain. P value
Cerebrospinal Fluid C-Reactive Protein Measurement—A Bedside Test in the Rapid Diagnosis of Bacterial Meningitis by M. John,* I. S. Raj,* R. Macaden,* T. S. Raghuveer,** M. Yeswanth,** andD. M. Meundi*** * Department of Microbiology, St. John's Medical College, Bangalore 560034, Karnataka, India ** Department of Pediatrics, St. John's Medical College Hospital, Bangalore 560034, Karnataka, India *** Department of Pediatrics, Vani Vilas Hospital, Bangalore 560002, Karnataka, India
C-reactive protein (C-RP) determinations were performed by tbe Latex agglutination method on the cerebrospinal fluid (CSF) samples of 212 patients with clinical features suggestive of meningitis. Patients were grouped as follows Group I: bacterial meningitis and partially treated bacterial meningitis (n = 22). Group II: viral encephalitis (n = 11). Group III: tuberculous meningitis (n = 18). Group IV: (i) febrile convulsions (n = 87); (ii) epileptic seizures (n = 70); (iii) intracranial haemorrhage (n = 4). C-RP was a better indicator of bacterial meningitis (sensitivity 91 per cent) than the Gram's stain (sensitivity 46 per cent). C-RP was positive in 91 per cent of patients in Group I, none in Groups II and III and 0.6 per cent in Group IV. C-RP determination in CSF proved to be a useful indicator of bacterial meningitis and served to distinguish it from viral encephalitis, tuberculous meningitis, febrile convulsions and other central nervous system disorders.
Introduction
C-Reactive protein (C-RP) is the prototype acute phase reactant. It's concentration is known to rise a thousand-fold in response to most forms of tissue damage, acute inflammation, and acute bacterial infection.1"8 The increase is rapid with prolonged elevated levels in serum and body fluids closely associated with the affected tissues.12 Hence C-RP detection in the cerebrospinal fluid (CSF) has found application as a sensitive indicator in distinguishing bacterial meningitis from other infections of the central nervous system.9"11 Although various methods for the rapid diagnosis of bacterial meningitis are available12"18 these have their limitations and may be unsuitable for use in developing countries.19 Acknowledgements The authors are grateful for the co-operation of the members of the Department of Microbiology, St. John's Medical College, and Department of Paediatrics, St. John's Medical College Hospital. The assistance given by Dr H. G. V. Rao and Mr A. S. Mohammed in the statistical analysis is gratefully acknowledged. They are also grateful for the secretarial assistance of Mrs Lakshmi Menon. Correspondence: Dr Ragini Macaden. Journal of Tropical Pediatrics
Vol.36
October 1990
This study was done to correlate CSF C-RP using a qualitative latex agglutination test9"1' with the conventional rapid diagnostic method—the Gram's stain in patients clinically diagnosed as having bacterial meningitis and partially treated bacterial meningitis, and to differentiate it from viral encephalitis, tuberculous meningitis, febrile convulsions, and other disorders of the central nervous system in a pediatric population. Materials and Methods
C-RP determination was carried out on cebrospinal fluid from 212 patients in the age group 15 days-12 years, admitted to the pediatric wards of St. John's Medical College Hospital and Vani Vilas Hospital, Bangalore, with clinical features suggestive of meningitis. The 212 patients were categorized into four groups. Group I: patients with clinical and laboratory evidence of bacterial meningitis and partially treated bacterial meningitis (n = 22; bacterial culture positive = 20; culture negative = 2). Group II: patients with clinical and laboratory evidence of encephalitis (n= 11). ) Oxford University Press 1990
213
Downloaded from http://tropej.oxfordjournals.org/ at University of Sussex on July 21, 2015
Summary
M. JOHN ET AL.
Group III: patients with clinical and laboratory evidence of tuberculous meningitis (n = 18). Group IV: patients with other CNS disorders (n = 161). (i) febrile convulsions—87; (ii) epileptic seizures—70; (iii) intracranial haemorrhage—4. CSF specimens were collected by lumbar punctures with sterile precautions and processed within 2 hours of collection as follows.
Biochemistry Estimation of glucose and protein concentration. Bacterial culture Centrifuged deposit plated on sheep blood, chocolate, MacConkey's agar, and thioglycollate medium. After 18 hours of incubation in a candle jar, the colonies were identified according to recommended methods.10
Bacterial isolates Staph. aureus H. inftutnzae S.pneumoniae E. coli Kleb. enterobacter sp. S. typhi Ps. aeruginosa No organisms Total
C-RP no.*
Grain's wtain no.*
6 2 3 3 2 1 3 2
4 2 3 3 2 1 3 2
4 1 I 1 1 1 1 0
20 (91%)
10 (46%)
22
•Numbers indicate samples of CSF positive for C-RP and showing the presence of bacteria on Gram's stain. P value
