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Abstract
How to cite this article: Sapra H, Singhal V. Managing Meningo-encephalitis in Indian ICU. Indian J Crit Care Med 2019;23(Suppl 2):S124-S128.
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Affiliation(s)
- Harsh Sapra
- Department of Neuroanesthesiology and Critical Care, Medanta - The Medicity, Gurugram, Haryana, India
| | - Vasudha Singhal
- Department of Neuroanesthesiology and Critical Care, Medanta - The Medicity, Gurugram, Haryana, India
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Zhang G, Yang C, Kang X, Gao Z, Wan H, Liu Y. The combination of cerebrospinal fluid procalcitonin, lactate, interleukin-8 and interleukin-10 concentrations for the diagnosis of postneurosurgical bacterial meningitis: A prospective study. Ann Clin Biochem 2018; 56:133-140. [PMID: 30056757 DOI: 10.1177/0004563218794729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background The differential diagnosis between postneurosurgical bacterial meningitis and aseptic meningitis remains challenging both for the clinician and the laboratory. Combinations of markers, as opposed to single ones, may improve diagnosis and thereby survival. Methods This prospective cohort study included patients with suspected bacterial meningitis after neurosurgery. The patients were divided into two groups according to the diagnostic criteria of meningitis involving a postneurosurgical bacterial meningitis group and a postneurosurgical aseptic meningitis group. Four biomarkers, including cerebrospinal fluid procalcitonin, lactate, interleukin-8 and interleukin-10 were assayed separately, and three algorithms were constructed using a linear combination. The area under the receiver operating characteristic curve was used to compare their performances. Results A cohort of 112 patients was enrolled in our study. Forty-three patients were diagnosed with postneurosurgical bacterial meningitis, and the cerebrospinal fluid values of their biomarkers were higher in patients with postneurosurgical bacterial meningitis than with postneurosurgical aseptic meningitis. The area under the receiver operating characteristic curves for the detection of postneurosurgical bacterial meningitis were 0.803 (95% confidence interval [CI], 0.724–0.883) for procalcitonin; 0.936 (95% CI, 0.895–0.977) for lactate; 0.771 (95% CI, 0.683–0.860) for interleukin-8; 0.860 (95% CI, 0.797–0.929) for interleukin-10; 0.937 (95% CI, 0.897–0.977) for the composite two-marker test; 0.945 (95% CI, 0.908–0.982) for the composite three-marker test and 0.954 (95% CI, 0.922–0.989) for the composite of all tests. The area under the receiver operating characteristic curves of the combination tests were greater than those of the single markers. Conclusions Combining information from several markers improved the diagnostic accuracy in detecting postneurosurgical bacterial meningitis.
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Affiliation(s)
- Guojun Zhang
- Department of Clinical Laboratory, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunjiao Yang
- Department of Clinical Laboratory, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xixiong Kang
- Department of Clinical Laboratory, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhixian Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong Wan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yunpeng Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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Abstract
The pathologic evaluation of spinal cord infections requires comprehensive clinical, radiological, and laboratory correlation, because the histologic findings in acute, chronic, or granulomatous infections rarely provide clues for the specific cause. This brief review focuses on the pathologic mechanisms as well as practical issues in the diagnosis and reporting of infections of the spinal cord. Examples are provided of the common infectious agents and methods for their diagnosis. By necessity, discussion is restricted to the infections of the medulla spinalis proper and its meninges, and not bone or soft tissue infections.
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Affiliation(s)
- Tarik Tihan
- Neuropathology Division, Department of Pathology, University of California San Francisco, Room M551, 505 Parnassus Avenue, San Francisco, CA 94143-0102, USA; Koc University School of Medicine, Istanbul, Turkey.
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