Abstract
All over the world, meningitis remains one of the most widespread neuroinfections
for adults and children. Successful initiation of treatment and prognosis depends
on rapid diagnosis. Diagnosis begins with a clear differentiation between bacterial
and viral characteristics of the causative agent. The aim of our research was to optimize
the diagnostic procedure used in Russian infectious diseases hospitals for children
with preliminary diagnosis of "meningitis". There were 232 patients (1 to 14 years
of age) hospitalized and observed in our Saratov State children infectious hospital
with preliminary diagnosis of “meningitis.” Diagnoses occurred on day 2.2 ± 0.7 from
onset of illness., It was impossible to differentiate bacterial or viral etiology
of meningitis on the basis of clinical observation or results of common laboratory
assays (mixed pleocytosis in analysis) cerebrospinal fluid (CSF). The results of our
research of these “acute phase of inflammation proteins” demonstrate that patients
with bacterial meningitis have serum C-reactive protein (CRP) levels higher than 24
mg/L (42.2 ± 5.1 mg/L, normal 0 mg/L), liquor CSF lactoferrin content – higher than
135.0 ng/L (342.6 ± 14.2 ng/L; normal 6.39 ± 1.7 ng/L), serum procalcitonin (PCT)
level – higher than 0.5 ng/mL. Patients with “viral meningitis” have serum CRP levels
lower than 18.0 mg/L (9.8 ± 1.1 mg/L, normal 0 mg/L), liquor CSF lactoferrin content
– lower than 120.0 ng/L (61.9 ± 7.8 ng/L, normal 6.39 ± 1.7 ng/L), serum PCT level
– lower than 0.5 ng/mL. For patients with “intermediate level” of CRP in their serum
samples (18.0–24.0 mg/L) or lactoferrin in their CSF samples (120.0–135.0 ng/L) test
on serum PCT content is highly recommended because in all cases gives unambiguous
results.
Keywords
Meningitis - enterovirus - coxsackieviruses - echoviruses - children
