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Comparitive Biochemical Profile of cerebrospinal Fluid and Serum in the Diagnosis of Pyogenic Meningitis
Abstract
Meningitis accounts for one of commonest neurological diseases in children and adults. To diagnose the pathogen there is need for reliable biochemical tests on CSF. This difficulty can partly be solved by estimation of CSF LDH, CRP and comparing it with their levels in Serum. The present study was undertaken to evaluate the clinical presentation and CSF analysis in pyogenic meningitis with special reference to LDH & CRP estimation. Study was conducted in. 32 cases of pyogenic meningitis between 18 years to 65 years were taken and 28 cases of individuals undergoing Lumbar puncture for various surgical procedures were taken as controls. Cases below 18 years, aseptic meningitis, traumatic and dry tap on lumbar puncture were excluded from the study. Lumbar puncture was done in all cases where indicated and CSF was collected in sterile bottles and blood was drawn within 1 hour of lumbar puncture. CSF and serum LDH was done by spectrophotometry using Systronics spectrophotometer. CRP was estimated by using Latex Slide Agglutination semi quantitative method (Accurex). Results were analyzed by descriptive statistical analysis. Analysis of variance (ANOVA), CHISQUARE TEST and Z TEST were used. ROC curves, Odds ratio and analysis of logistic regression were done to establish the best diagnostic marker. SSPS 17 and Met cal statistical software was used for statistical analysis. CSF protein was significantly high and CSF/ serum ratio was altered. In majority of cases CSF sugar was less than 2/3 of blood sugar and absent in most of them. LDH was significantly high and CSF/ serum ratio was altered. CRP was positive in almost all cases and was in the range of 0.6 to 9.6 mg/dl and values were corresponding in the serum. CRP and LDH showed a high ODDS ratio and high significance compared to other parameters. CSF CRP is a novel marker with high sensitivity and specificity. LDH and CRP being rapid and cost effective can be used as a supportive evidence of meningitis, along with other routine tests to diagnose pyogenic meningitis.
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Treatment of bacterial meningitis depends on its severity. The signs, symptoms, and laboratory values of 51 patients with bacterial meningitis admitting to the Department of Pediatrics at Sendai City Hospital from January 1985 to December 1994 were analyzed in order to evaluate their prognostic value. The overall mortality rate was 3.9%. The incidence of neurological deficit on discharge was 31.4%. According to their prognoses, patients were divided into two groups: those who recovered with no detectable disabilities (good prognosis) and those who died or were left with neurological deficits (poor prognosis). An analysis of these groups using Fisher's exact probability test revealed that the following risk factors were associated with poor prognosis: 1) duration of fever (including the periods of relapse) for more than 10 days ; 2) abnormal findings on brain imaging, such as cerebral infarction, cerebral hemorrhage, cerebral abscess and subdural effusion: 3 initial serum CRP value above 16 mg/dl; 4) initial CSF glucose value below 12 mg/dl; and 5) initial CSF LDH value above 220 IU/l. Streptococcus pneumoniae infection carried the worst prognosis: the causal organism of both the two fetal cases was S. pneumoniae. The incidence of poor prognosis was also high in S. pneumoniae meningitis (60.0%), compared to those by Hemophilus influenzae (46.7%) and group B streptococcus (25.0%). In the cases in which causal agents were not detected, this incidence was as low as 10 percent, showing significant difference from cases in which causal agents were identified. In order to improve the prognosis of bacterial meningitis, factors associated with poor prognosis should be recognized at early stages of the illness.
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