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Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

C-reactive protein has been a measure of acute phase reactions to inflammation for 40 years. Recently improved quantitative assays in serum and cerebrospinal fluid (CSF) have allowed a re-evaluation of its potential as a diagnostic laboratory test. The main advances in the newer methods have been that they can provide rapid (hours) information on the hepatocyte synthesis of this molecule during immune response. We have tested its value in patients with presumed bacterial meningitis. Based on our experience, newer standardized, quantitative assessments of C-reactive protein can be very useful in distinguishing between bacterial and other forms of meningeal irritation during the first few days of hospitalization. Other investigators have indicated that by serial measurements important information on the resolution or continuation of inflammatory processes can be obtained. We recommend improved standardization of this test, and recalculation of its usefulness as a diagnostic laboratory test.
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PMID:C-Reactive Protein: Re-evaluation of a Diagnostic Laboratory Test. 1110 41

The levels of C-reactive protein (CRP) and serum amyloid A protein (SAA) in blood are increased in patients with inflammatory diseases as acute phase proteins. Most of the presently used indicators of inflammation, such as body temperature, white cell count, erythrocyte sedimentation rate or CRP, are non-specific parameters. In contrast, procalcitonin (PCT) has been reported to be selectively induced by severe bacterial infection during the systemic inflammatory response syndrome (SIRS), and also in sepsis or multiorgan dysfunction syndrome. PCT expression is only slightly induced, if at all, by viral infections, autoimmune disorders, neoplastic diseases and trauma of surgical intervention. We measured the concentrations of CRP, SAA and PCT in the sera and cerebrospinal fluid (CSF) of 30 patients with bacterial, viral, or mycotic meningitis, and 12 patients with a noninflammatory central nervous system disease as controls. An extremely high CRP level in CSF of above 100 microg/L was seen in all seven bacterial meningitis patients and in only 10% of the viral meningitis patients. A high SAA level in CSF of greater than 10 microg/L was observed in all of the bacterial meningitis and mycotic meningitis patients, and in 95% of the viral meningitis patients. Among those with bacterial meningitis, the serum PCT level was more elevated in those with more serious bacterial meningitis. The PCT level in the CSF did not significantly differ among the patients with the three types of meningitis. However, the serum PCT level was very high above 0.1 microg/L in all seven bacterial meningitis patients, especially in the clinically serious cases.
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PMID:Levels of three inflammation markers, C-reactive protein, serum amyloid A protein and procalcitonin, in the serum and cerebrospinal fluid of patients with meningitis. 1176 15

The objective of our study was to assess the value of serum procalcitonin (PCT) monitoring in the differential diagnosis of ventriculitis in adult intensive care (ICU) patients. We analyzed 15 consecutive patients with ventriculitis in which a ventricular catheter had been inserted and contrasted these data with the observations in 10 patients with community-acquired bacterial meningitis. Cerebrospinal fluid (CSF) and blood samples were collected daily to assess serum PCT, C-reactive protein (CRP) and CSF leukocyte count. PCT levels were normal or slightly elevated in patients with ventriculitis with either positive or negative CSF bacterial culture but elevated in patients with bacterial meningitis. A PCT cut-off value of 1.0 ng/ml or more showed a specificity of 77% and a sensitivity of 68% for ventriculitis with positive CSF bacterial culture. Serum PCT levels reflected more accurately the time phases of disease during therapy. We conclude that the monitoring of serum PCT alone is not helpful for the differential diagnosis of ventriculitis, in contrast to that of bacterial meningitis. The value of PCT as an additional marker with which to assess the efficacy of therapy in ventriculitis is suggested, but requires further assessment.
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PMID:Serum procalcitonin monitoring for differential diagnosis of ventriculitis in adult intensive care patients. 1190 66

Laboratory services contribute to the management of patients with neurosurgical infections in a variety of ways and, in so doing, increase the likelihood of a favourable outcome. Microbiology laboratories and clinical microbiologists are able to confirm the diagnosis, identify the causative agents and facilitate optimal antimicrobial therapy. Other pathology specialties perform investigations which help neurosurgeons to differentiate between postoperative aseptic and bacterial meningitis, these disease processes being indistinguishable on clinical grounds. A broad range of variables have been evaluated to date, but only the lactate and interleukin-1beta concentrations in cerebrospinal fluid have been shown to have sufficiently high sensitivities and specificities to be useful for this purpose. In preliminary studies measurement of the serum C-reactive protein concentration has been shown to be an effective criterion for monitoring the response to antibacterial therapy in patients with spinal extradural abscesses, postoperative discitis, brain abscesses and subdural empyemas, thereby enabling patients to be treated successfully with courses of these drugs that are markedly shorter than those currently recommended.
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PMID:Infections in neurosurgery: using laboratory data to plan optimal treatment strategies. 1192 38

The prognosis of bacterial meningitis is critically dependent on a rapid causal diagnosis and implementation of an accurate treatment. However, clinical and biological parameters available within the few hours that follow the patient's admission are not reliable enough, except when bacteria are to be found in cerebrospinal fluid under the microscope. Therefore, the initial treatment of acute meningitis is still most of time presumptive so that the definitive diagnosis, however difficult, is often established when the therapeutic management has already been initiated. The use of biological markers, especially lymphokines and acute-phase proteins, has been proposed to facilitate the accuracy of the initial diagnosis. Today, C-reactive protein (CRP) is the most widely used inflammatory marker in emergency departments with aim to discriminate bacterial from viral infections. In 1998, Gerdes et al. published a meta-analysis from 35 studies questioning the usefulness of CRP in discriminating bacterial meningitis from viral meningitis. They outlined that the majority of authors proposed to use this inflammation marker as an additional tool for discriminating bacterial meningitis from viral meningitis, without having evaluated its independent contribution relative to other parameters such as white blood cell count, cerebrospinal fluid (CSF) white cell count, protein or glucose. Procalcitonin (PCT) is an acute-phase protein with faster kinetics than CRP, its concentration in serum rising within the few hours that follow the inception of a bacterial infection. Two French studies published in 1997 and 1998 have shown that, using a cut-off range of 0.5 through 2 ng/mL, the sensitivity and specificity of PCT were 100% in discriminating bacterial meningitis from viral meningitis. Some of the seven studies published since seemed to demonstrate the usefulness of PCT in diagnosing meningitis. Finally, PCT was used effectively to shorten unnecessary antibiotic treatment for children seen in an hospital in Paris (France) during summer 2000.
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PMID:[Acute meningitidis, acute phase proteins and procalcitonin]. 1270 67

We report a case of sphenoid sinusitis which could be diagnosed by orbital CT after detecting Strepotococcus pneumoniae from blood culture. A previously healthy 47 year-old Japanese male was admitted to our hospital with severe left-sided headache of 2 days duration. From 9 days before hospitalization (1st day), the patient complained of cough and sputum. On physical examination, his neck was supple and his temperature was 38.3 degrees C. The rest of the examination was normal. A chest radiograph, sinus radiograph, and head computed tomographic (CT) scan without contrast material disclosed no abnormalities. Lumbar puncture was done and cerebrospinal fluid was clear and cell counts and the levels of glucose and protein were normal. The peripheral white blood cell count was 14,400/fl, and the C-reactive protein level was 9.6 mg/dl. After blood, urine, pharyngeal mucus and cerebrospinal fluid cultures were obtained, empirical antibiotic therapy with 2 gms of piperacillin twice daily was begun. He complained sever left-sided retro-orbital headahe on the next day too. The lumbar puncture and head CT scan with contrast material was done again but gave no diagnostic clues. The examinations by the otolaryngologist, ophthalmologist and dentist found no abnormal findings. On the 3rd hospitalized day, Strepotococcus pneumoniae was detected from the blood culture taken on the 1st hospitalized day. A CT scan focused on orbita was done and revealed a low density area of the left sphenoid sinus. The dose of piperacillin was increased to 4 gms twice daily and continued for 24 days. The patient's headache improved and piperacillin was changed to oral levofloxacin 100 mg, three times daily on the 26th day. The medication was stopped on the 73th day. Isolated sphenoid sinusitis is rare, but crtitical complications such as cranial nerve involvement, brain abscess, and bacterial meningitis may happen. It is necessary to also think of sphenoid sinusitis in practices of patients with severe headache.
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PMID:[A case of sphenoid sinusitis which could be diagnosed by orbital computed tomography after detected Strepotococcus pneumoniae from blood culture]. 1597 60

Acute bacterial meningitis (BM) which is a pediatric emergency with high mortality and morbidity, must be diagnosed and treated promptly. There is no unique method to prove or rule out the diagnosis of BM in a patient with cerebrospinal fluid (CSF) findings consistent with BM but negative Gram stain and culture results. For this purpose the combination of CSF parameters are used for diagnosis. The aims of this study were to compare retrospectively the mean leukocyte count, serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), CSF leukocyte and neutrophil, CSF protein and glucose values in 40 bacterial and 29 viral meningitis (VM patients, ages between 1 month and 14 years, and to develop a statistical model for the differentiation of BM and VM cases. Logistic regression analysis was used to investigate the relationship between BM and age, CPR, ESR, leukocyte count, CSF leukocyte, neutrophil, protein and glucose values. Based on CSF protein and neutrophil ratio which were found as independent variables, the regression model could predict the patients having BM with 95% and viral meningitis with 93.2% accuracy.
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PMID:[Differential diagnosis of bacterial and viral meningitis in childhood acute meningitis: a statistical model]. 1742 53

Serial C-reactive protein (CRP) measurements appear to be helpful in following clinical course and response to treatment of serious bacterial infections in neonates, such as meningitis, septicaemia and osteomyelitis. In previous studies, serial determination of serum CRP could detect potential complications of meningitis, such as subdural effusion, purulent arthritis and osteomyelitis, and secondary skin infection. We report an 11-day-old full-term male neonate with persistent positive CRP after treatment of bacterial meningitis, and who developed hydrocephaly at follow-up. We concluded that positive CRP was secondary to aqueduct gliosis; therefore monitoring of serum CRP levels in infants with bacterial meningitis represented useful information, not only in persistent or secondary infection, but also for destructive complications of meningitis.
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PMID:C-reactive protein as an indicator of aqueductal gliosis and hydrocephaly in neonatal meningitis. 1858 Oct 11

Meningitis continues to be a formidable illness with high morbidity and mortality among children in India. The present study was undertaken to prospectively look for the prevalence of pyogenic meningitis at Gulbarga and to find out the utility of gram stain, Latex Agglutination Test and (LTA) and C-reactive protein in the rapid diagnosis of pyogenic meningitis from children. Over a 48-months period, 535 children with a presumptive clinical diagnosis of acute bacterial meningitis were investigated by direct microscopy, CRP, bacterial culture, latex agglutination test (L TA), cell count and cell type and biochemical tests. Latex Agglutination Test (LA T) was done for detection of the antigens of Streptococcus pneumoniae, Group B Streptococci, E. coli, Neisseria meningitidis and Haemophilus influenzae type b. Among 535 suspected meningitis cases, 291 cases were diagnosed as pyogenic meningitis cases based on biochemical tests, cell count and cell type. Out of 291 cases, 55 cases have already received antibiotic treatment. Among 236 cases of untreated pyogenic meningitis cases, 199 CSF samples were culture positive. Streptococcus pneumoniae (44.7%) was the predominant organism identified, followed by H influenzae (25.6%) and Gp. B. Streptococci (9.5%). 208 of 236 cases were gram-stain positive, 129 cases had elevated CSF-CRP and 214 cases were diagnosed as pyogenic meningitis by the detection of bacterial antigens by latex agglutination test. Among 55 pretreated cases, only 05 (9.1%) CSF samples were culture positive, bacteria was observed in 36 gram stain smear, CRP was elevated in 16 CSF samples and 52 pretreated cases of suspected meningitis were diagnosed as pyogenic meningitis by latex agglutination test for detection of bacterial antigens. Many of the bacterial isolates were sensitive to gentamicin, cefotaxime and ceftriaxone and least sensitive to tetracycline and gentamicin. 13.1% of gram-negative bacilli were ESBL producers. To conclude, inclusion of latex agglutination test for detection of bacterial antigen in the routine diagnosis adds a valuable adjunct in the rapid and accurate diagnosis of pyogenic meningitis.
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PMID:Bacterial meningitis: rapid diagnosis and microbial profile: a multicentered study. 1930 95

Differentiation of serious bacterial infection (SBI) from self-limiting viral illness in febrile infants younger than three months is a significant challenge for clinicians. We aimed to assess the risk factors for SBI in febrile infants. Data were obtained from 221 infants younger than three months who visited a single community referral hospital for fever and underwent a complete sepsis workup between August 2003 and July 2006. The causes of fever were febrile illness without a documented cause (FISDC, 65%), urinary tract infection (UTI, 12%), aseptic meningitis (12%), bacteremia (4%), bacterial meningitis (2%). Cerebrospinal fluid enterovirus polymerase chain reaction was positive in 28% of FISDC and 48% of aseptic meningitis cases. When UTI was excluded, the risk factors for SBI were 1) C-reactive protein (CRP) level of > or =1.87 mg/dL and 2) fevers of > or =38.9 degrees C. The specificity and negative predictive values of risk factors 1) and 2) for the diagnosis of SBI were 94% and 95%, respectively. We concluded that enteroviral infection may be a major cause of febrile episodes in infants younger than three months. If UTI could be excluded, the presence of CRP levels > or =1.87 mg/dL and fevers of > or =38.9 degrees C can be used as criteria to rule out SBI in these infants.
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PMID:Risk factors for serious bacterial infection in febrile young infants in a community referral hospital. 1979 81


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