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

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); P<0.001. Procalcitonin levels were more sensitive and specific (79%, 81%) than C-reactive protein (76%, 75%) and white blood cell count (72%, 75%) in the diagnosis of bacterial meningitis.

Conclusion: Elevated serum procalcitonin level could be a predictor of bacterial causes of meningitis and is more sensitive and specific than other diagnostic predictors.

Keywords: Bacterial Meningitis; C-Reactive Protein; Nonbacterial; Procalcitonon; White Blood Cell.

Fig. 1:

ROC curve for WBC: white blood cell, CRP: C-reactive protein and serum procalcitonin