Background:In children with meningitis, there is a difficulty to verify the etiology as viral or bacterial. Therefore, intensive research has been carried out to find new and rapid diagnostic methods for differentiating bacterial from viral meningitis.Objectives:The aim of this work was to study the behavior of procalcitonin (PCT) and whether it can be used to differentiate children with bacterial from those with viral meningitis. We also compared PCT to C-reactive protein (CRP) and white blood cell count.Patients and Methods:Forty children aged from 4 months to 12 years with clinically suspected meningitis were studied. Lumbar punctures were done for all cases before starting initial antibiotic treatment. According to the results of bacterial cultures and cerebrospinal fluid (CSF) cytochemical profile, our patients were classified into two groups: bacterial meningitis group and viral meningitis group. PCT, CRP, and leukocyte count were measured at the time of admission and after 3 days.Methods:Forty children aged from 4 months to 12 years with clinically suspected meningitis were studied. Lumbar punctures were done for all cases before starting initial antibiotic treatment. According to the results of bacterial cultures and cerebrospinal fluid (CSF) cytochemical profile, our patients were classified into two groups: bacterial meningitis group and viral meningitis group. PCT, CRP, and leukocyte count were measured at the time of admission and after 3 days.Results:PCT levels were significantly higher in patients with bacterial meningitis (mean, 24.8 ng/ml) compared to patients with viral meningitis (mean, 0.3 ng/ml) (P<0.001). PCT levels in bacterial meningitis group decreased after 3 days of starting treatment, but remained higher than viral meningitis group (mean, 10.5 ng/ml). All CSF parameters, blood leukocytes, and CRP showed overlapping values between the two groups. Serum PCT with cut off value >2 ng/ml showed sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 66%, 68%, and 100%, respectively, for the diagnosis of bacterial meningitis.Conclusion:Serum procalcitonin level has a better diagnostic and prognostic value than CRP or leukocyte count to distinguish between bacterial and viral meningitis. It is also a good indicator of the efficacy of treatment of bacterial meningitis.

Significant proximal tubular dysfunction was a feature in the SCD group, indicated by high urinary RBP and β2-microglobulin excretion. Assessing the urinary excretion of these low molecular weight proteins in children with sickle cell disease at different points of diagnosis may add key clinical information to the follow up of renal tubular function in patients with SCD.

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