Iran J Pediatr Dec 2014; Vol 24 (No 6), Pp: 739-744

Original Article

Diagnostic Value of Serum Procalcitonin Level in Differentiating Bacterial from Nonbacterial Meningitis in Children Raid M.R. Umran*, MD; Nabeel Hashim Radhi, DCH Al-Zahra Teaching Hospital, College of Medicine, University of Kufa, Iraq

Received: May 03, 2014; Accepted: Jul 18, 2014; First Online Available: Dec 09, 2014

Abstract Objective: Acute bacterial meningitis in pediatrics remains a serious and potentially lethal disease. Its prognosis is critically dependent on rapid diagnosis and treatment. The use of biological markers, like procalcitonin, has been proposed to facilitate the accuracy of the initial diagnosis of bacterial meningitis. The aim of this study was assessment the diagnostic values of serum procalcitonin (PCT) assay in the diagnosis and differentiation of acute bacterial from non bacterial meningitis.

Methods: 45 patients with suspicion of meningitis were enrolled in the study and were clinically evaluated and investigated by lumbar punctures for cerebrospinal fluid analysis, C-reactive protein and differential leukocyte count. Patients with clinical and laboratory suggestion of bacterial causes were regarded as bacterial meningitis group (29 patients), and those who were suggestive of nonbacterial causes were regarded as nonbacterial group (16 patients). Findings: Serum procalcitonin levels were significantly higher in bacterial meningitis group (637±325 pg/ml) compared with non-bacterial meningitis (380±170 pg/ml); P0.2g/l, decreased glucose ratio 1500×106/L and polymorph nuclear leukocyte domination), 29 patients were included in the suspicious of bacterial meningitis group and 16 patients with none of the above findings were regarded as nonbacterial meningitis group. Due to relatively high rate of false negative CSF cultures in our hospital’s laboratory and delay in maintaining results, the CSF culture was not regarded as parameter in differentiating the cases in both groups. All patients with suspicion of meningitis admitted to pediatric ward were treated with the standard management and followed until discharge. Parents of eligible newborns were approached for participation in the study and informed consent was obtained from them. Study was approved by ethical and scientific committee of the hospital and college of medicine, University of Kufa. Primary outcome was to evaluate the procalcitonin as a marker for diagnosis of bacterial meningitis, secondary outcome to compare and assess procalcitonin sensitivity and specificity. Statistical analysis was done using SPSS version 20.0 (Statistical Package for the Social Sciences, Chicago, IL). Data were expressed as number and percentage for qualitative variables, mean±standard deviation for quantitative ones, chi square test and Student t test were used to compare and ROC curve used for the sensitivity and specificity. P. value less than 0.05 was considered significant.

Iran J Pediatr; Vol 24 (No 6), Dec 2014 Published by: Tehran University of Medical Sciences (http://ijp.tums.ac.ir)

Umran R.M.R, et al

741

Clinical features

Table 1: Characteristics and clinical features of all studied groups

Age(month) Male Female Disturbed Consciousness Irritability Lethargy Convulsion Fever Vomiting Bulging fontanel Headache Photophobia Skin rash Neck stiffness Kernig sign Brudzuniski sign Sex

Total patients (n=45) 17.7 (17.6) 26 (58%) 19 (42%) 8 (17.7%) 23 (51.1%) 16 (35.5%) 33 (73.3%) 44 (97.7%) 42 (93.3%) 16 (35.5%) 12 (26.6%) 4 (0.8%) 3 (0.6%) 14 (31.1%) 2 (0.2%) 2 (0.2%)

Bacterial meningitis (n=26) 17.6 (20.2) 17 (65%) 12 (35%) 3 (10%) 13 (44%) 12 (41%) 19 (65%) 28 (96%) 27 (93%) 11 (37%) 11 (37%) 4 (13%) 3 (10%) 8 (27%) 2 (6%) 2 (6%)

Findings From the 45 patients enrolled in this study, 26 patients were clinically diagnosed as bacterial meningitis and 19 patients with no evidence of bacterial causes of meningitis. The mean age of the studied population was (17.7±17.6) months and 58% were females. The most common clinical presentations were fever (97.7%), vomiting (93.3%) and convulsions (73.3%), as shown in Table 1. The CSF neutrophil cell count and protein were higher in bacterial meningitis group than in nonbacterial (P

Diagnostic value of serum procalcitonin level in differentiating bacterial from nonbacterial meningitis in children.

Acute bacterial meningitis in pediatrics remains a serious and potentially lethal disease. Its prognosis is critically dependent on rapid diagnosis an...
230KB Sizes 1 Downloads 8 Views

Recommend Documents


Diagnostic value of lactate, procalcitonin, ferritin, serum-C-reactive protein, and other biomarkers in bacterial and viral meningitis: A cross-sectional study.
There are many difficulties distinguishing bacterial from viral meningitis that could be reasonably solved using biomarkers. The aim of this study was to evaluate lactate, procalcitonin (PCT), ferritin, serum-CRP (C-reactive protein), and other known

Relationship of Serum Procalcitonin Levels to Severity and Prognosis in Pediatric Bacterial Meningitis.
To investigate the relationship between serum procalcitonin (PCT) levels and prognosis in children with bacterial meningitis.

The diagnostic value of cerebrospinal fluids procalcitonin and lactate for the differential diagnosis of post-neurosurgical bacterial meningitis and aseptic meningitis.
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-neurosurg

Serum procalcitonin and C-reactive protein for differentiating bacterial infection from disease activity in patients with systemic lupus erythematosus.
To study the clinical value of procalcitonin (PCT) and C-reactive protein (CRP) in differentiating bacterial infection from disease activity in systemic lupus erythematosus (SLE) patients.

Predictive performance of serum procalcitonin for the diagnosis of bacterial meningitis after neurosurgery.
Postoperative bacterial meningitis (PBM) is a serious potential complication after neurosurgery. Early diagnosis and introduction of antimicrobial therapy are necessary to reduce the rate of fatal outcomes from PBM. However, PBM is not easily differe

Diagnostic value of procalcitonin for bacterial infection in elderly patients - a systemic review and meta-analysis.
To summarise evidence for the diagnostic accuracy of procalcitonin (PCT) tests for identifying systemic bacterial infections in elderly patients.

Can serum procalcitonin measurement help monitor the treatment of acute bacterial meningitis? A prospective study.
Previous studies have demonstrated the value of serum procalcitonin (PCT) as a marker of bacterial infection, as well as the rapid decrease in its concentration with appropriate antibiotic treatment. The aim of this study was to determine the variati

Diagnostic value of serum procalcitonin for acute pyelonephritis in infants and children with urinary tract infections: an updated meta-analysis.
The aims were to assess (1) the diagnostic value of serum procalcitonin (PCT) for acute pyelonephritis (APN) in infants and children with urinary tract infections (UTIs) and (2) to compare the performance of two commonly used cutoff values.

Value of procalcitonin in differentiating pulmonary tuberculosis from other pulmonary infections: a meta-analysis.
To systematically and quantitatively summarise the current evidence on the utility of the procalcitonin test (PCT) in discriminating pulmonary tuberculosis (TB) from other pulmonary infections.

Diagnostic and prognostic value of serum procalcitonin concentrations in primary lung cancers.
Procalcitonin (PCT) is widely used for the diagnosis of bacterial infections. The aim of this study was to evaluate PCT as a tumor and as a prognostic marker in patients with primary lung cancer.