Investigating Blood Biomarkers That Can Facilitate the Diagnosis of Meningitis-A Systematic Literature Review

Abstract

Meningitis is an inflammation of the meninges that can sometimes be a life-threatening disease. Therefore, fast and proper diagnosis with the implementation of adequate treatment is crucial in its management. Treatment depends on etiology, which can be viral, bacterial, fungal, and parasitic. Diagnosis is based on thorough clinical examination with a performance of lumbar puncture in the case of meningitis suspicion. This procedure, however, remains invasive with several contraindications and a need for a patient's consent, which is not always given due to the patient's fear of it, for instance. Thus, this systematic review aimed to summarize the available literature on the topic of blood biomarkers in meningitis differentiation. A selection process was performed by two authors independently in accordance with the Preferred Research Items for Systematic Reviews and Meta-analyses. Two databases were screened. It led to the identification of 863 articles, of which 43 were eventually included in the systematic review. The analysis resulted in identifying blood biomarkers in both adult and pediatric meningitis. Most studies focused on inflammatory markers, such as C-reactive protein and procalcitonin, from which procalcitonin showed better utility. Among other analyzed molecules were, for instance, interleukins, apolipoproteins, and microRNAs. Moreover, many researchers suggested that combining biomarkers or implementing novel technologies may lead to the best accuracy. However, many suggested methods lack validation, which stands in the way of making them widely used.

Keywords: biomarker; infectious diseases; inflammation; lumbar puncture; meninges; meningitis; sepsis.

Figure 1

A flowchart of the selection process performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. n, number of studies.

Figure 2

A summary of putative blood biomarkers in meningitis with a division to different age populations. Aβ42, amyloid-beta 42; AChE, acetylcholinesterase; Apo, apolipoprotein; CD, cluster of differentiation; CFH, complement factor H; CRP, C-reactive protein; CXCL-10, C-X-C motif chemokine ligand 10; ESR, erythrocyte sedimentation rate; IFN-γ, interferon-gamma; IL, interleukin; miR, microRNA; NCAM1, neural cell adhesion molecule 1; NFL, neurofilament light chain; NGAL, neutrophil gelatinase-associated lipocalin; NSE, neuron-specific enolase; PCT, procalcitonin; S100B, S100 calcium-binding protein B; SAA, serum amyloid A; sCD163, soluble CD163.