Rendimiento diagnóstico de la procalcitonina y la proteína C reactiva para predecir meningitis bacteriana en los ancianos en urgencias

The usefulness of hematological parameters and cerebrospinal fluid indexes in the differential diagnosis of acute bacterial from viral meningitis

Central nervous system (CNS) infection is a medical emergency with an important cause of mortality worldwide. The 79 patients with confirmed acute CNS infection (48 bacterial and 31 viral meningitis) were evaluated. Bacterial meningitis score, cerebrospinal fluid (CSF)/serum glucose ratio, and CSF/serum albumin ratio had the highest area under the curves (0.873, 0.843, 0.810, respectively) for discriminating bacterial meningitis. Neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte ratio (PLR) and CSF lactate dehydrogenase have a good ability for the differential diagnosis of bacterial meningitis. CSF/serum glucose ratio, NLR (with a cut-off value> 8.87), large unstained cell, total protein, albumin, and procalcitonin levels were found to be predictors for mortality. NLR can be used as a biomarker to differentiate bacterial meningitis from viral meningitis and to predict the prognosis of CNS infection. CSF/serum albumin ratio and CSF lactate dehydrogenase can be used to predict bacterial meningitis as well as CSF/serum glucose ratio.

Epidemiological, Cytochemical and Bacteriological Profile of Meningitis among Adults and Children in North West of Morocco

BACKGROUND AND OBJECTIVE

Meningitis is a medical and public health problem in Morocco, particularly in the North West region. The purpose of present study was to identify the pathogen in pyogenic meningitis and to determine its antibiotic susceptibility pattern Materials and Methods: A total of 247 cases were included in the diagnosis of meningitis on the basis of clinical findings and positive cerebrospinal fluid (CSF).

RESULTS

The study included 247 cases with a mean cumulative incidence of 4.53 (100,000 Hts) meningitis in all forms during the study period. The sex ratio M/F was 1.71. Maximum numbers of cases were<15 year of age, 139 (56.3%). Bacterial meningeal syndrome was observed in 67.2% of cases. Cerebrospinal fluid (CSF) was cloudy in 57.1% of cases. The average number of GBs was 1074.12 (±2115.63) elements mm-3. Mean glycorrhachia was 0.48 g L-1 (±0.28) and mean protein levels were 1.5 g L-1 (±1.68). The common pathogens identified on CSF culture were coagulase, negative Neisseria meningitidis in 30 (13%) and Streptococcus pneumoniae 6 (2.5%). Overall mortality was 14.9%.

CONCLUSION

Hence, Meningitis is a real health problem in the province of Kenitra, affecting especially children. Effective involvement of all health personnel and the community fight this epidemic disease.

The Role of Procalcitonin in the Diagnosis of Meningitis: A Literature Review

OBJECTIVE

To review the current published literature on the use of procalcitonin as a diagnostic and prognostic marker in adult patients with meningitis.

METHODS

We conducted a PubMed search to identify all relevant publications regarding the diagnostic and prognostic value of serum procalcitonin in patients with a known or suspected central nervous system infection. We also reviewed the bibliographies of all identified manuscripts in an attempt to identify additional relevant references.

RESULTS

A significant body of evidence suggests that serum procalcitonin has a promising role and can be a useful biomarker in the assessment of patients with meningitis.

CONCLUSIONS

Our literature review suggests that data on the role of Cerebrospinal Fluid (CSF) procalcitonin are limited, whereas serum procalcitonin (S⁻PCT) is probably a useful tool in the evaluation of patients with a known or suspected central nervous system infection and can help distinguish between bacterial and viral meningitis.

Usefulness of blood and cerebrospinal fluid laboratory testing to predict bacterial meningitis in the emergency department

INTRODUCTION

The classic clinical presentation of bacterial meningitis (BM) is observed in less than half of the cases in adults, and symptoms are less specific in children, the elderly or immunocompromised, and other chronic patients. The usual signs and symptoms do not provide optimal sensitivity and specificity for distinguishing possible BM from viral meningitis (VM), which may lead to a delay in the appropriate antimicrobial therapy. Society therefore stands to benefit from the development of effective, objective, and rapid tools able to predict and identify patients with BM. These tools include laboratory tests for blood and cerebrospinal fluid (CSF). The aim of this review is to summarise recently published scientific evidence in order to clarify existing controversies and compare the usefulness and diagnostic ability of the different parameters used to predict BM.

DEVELOPMENT

Systematic search of the main bibliographic databases and platforms to identify articles published between January 2000 and January 2016. We selected 59 articles that meet the objectives of this review.

CONCLUSIONS

CSF lactate, proportion of polymorphonuclear leukocytes, and CSF glucose, as well as serum procalcitonin (PCT), are the independent factors most predictive of bacterial aetiology. The model that combines serum PCT and CSF lactate achieves the highest predictive power for BM, with a sensitivity and specificity exceeding 99%. We should consider BM when CSF lactate >33 md/dL and/or PCT>0.25ng/mL.

Usefulness of procalcitonin and C-reactive protein for predicting bacteremia in urinary tract infections in the emergency department

INTRODUCTION

The aim of this study was to analyze and compare the capacity of procalcitonin (PCT), C-reactive protein (CRP), lactate and leukocytes to predict the presence of bacteremia in patients with urinary tract infections (UTIs).

METHODS

Observational, retro-prospective analytical study of adult patients (≥15 years) diagnosed with UTI in an emergency department from August 2012 to January 2013.

RESULTS

The study included 328 patients diagnosed with UTI, with a mean age of 52±22 years, 74% of whom were women. Of these, 43 (13.1%) had bacteremia. For predicting bacteremia, PCT achieved the largest area under the receiver operating characteristic curve (ROC-AUC) at .993 (95% CI .987-1; P<.001). A cutoff≥1.16ng/mL achieves a sensitivity of 100%, a specificity of 97%, a positive predictive value of 84% and a negative predictive value of 100%. Lactate achieved an ROC-AUC of .844, and CRP achieved only .534. The mean values when comparing PCT levels in patients with UTIs with and without bacteremia were 8.08±16.37 and .34±.37ng/mL, respectively (P<.001).

CONCLUSIONS

For patients with UTIs in the emergency department, PCT achieves considerable diagnostic performance for suspecting bacteremia, a performance greater than that of lactate, CRP and leukocytes.