Value of cerebrospinal fluid analysis and serum inflammatory markers for distinguishing between viral and bacterial meningitis in children in early phase of the disease

Abstract

Background Regardless of cerebrospinal fluid (CSF) examination there are difficulties distinguishing between bacterial and viral meningitis in early phase of the disease which leads to unnecessary use of antibiotics. A retrospective analysis of 175 cases of children with acute meningitis (defined by a leukocyte count >5 per mm in the CSF) who were hospitalized in Kaunas Clinical Hospital from 2008 to 2016 and underwent lumbar puncture during the first 48 hours of the disease was performed. CSF parameters (WBC count, absolute neutrophil count (ANC), protein level) and serum inflammatory markers (CRP and WBC count) as potential predictors of bacterial meningitis (BM) were compared. 3 The age of included patients ranged from 6 months to 18 years. 16 of them were diagnosed with bacterial meningitis and 159 with viral meningitis. Of all evaluated markers, CSF WBC count had the highest area under the ROC curve (AUC) of 0.95 (p<0.001, 95% CI, 0.893-1.00) with 100% sensitivity (52.8% specificity) when CSF WBC count was ≤104 cells/μl. CSF protein ≤0.4 g/l had 100% sensitivity (68.6% specificity) for BM. Serum inflammatory markers (CRP and leukocytosis) were less useful with CRP having an AUC of 0.887 (p<0.001, 95% CI, 0.769-1.00) and leukocytosis of 0.841 (p<0.001, 95% CI, 0.741-0.941). CRP had 100% specificity (64.7% sensitivity) when above 68.5 mg/l. CSF WBC count, CSF ANC, CSF protein level, serum CRP and serum WBC count were useful biomarkers for distinguishing between bacterial and viral meningitis, based on their AUC values. At early phase of the disease CSF WBC count was the most reliable predictor of BM.