Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis

Viallon, Alain; Desseigne, Nicolas; Marjollet, Olivier; Birynczyk, Albert; Belin, Mathieu; Guyomarc'h, S.; Borg, Jacques; Pozetto, Bruno; Bertrand, Jean Claude; Zéni, Fabrice

doi:10.1186/cc10254

Cited by 137 publications

(93 citation statements)

References 37 publications

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“…PCT has been proven to be valuable in differentiating between bacterial and viral meningitis when determined in serum (Dubos et al., 2008; Gendrel et al., 1997; Viallon et al., 2011). However, the usefulness of PCT in serum of patients with bacterial meningitis after neurosurgical intervention is limited (Choi & Choi, 2013).…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin in cerebrospinal fluid in meningitis: a prospective diagnostic study

Alons¹,

Verheul²,

Kuipers³

et al. 2016

Brain and Behavior

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ObjectivesBacterial meningitis is a severe but treatable condition. Clinical symptoms may be ambiguous and current diagnostics lack sensitivity and specificity, complicating diagnosis. Procalcitonin (PCT) is a protein that is elevated in serum in bacterial infection. We aimed to assess the value of PCT in cerebrospinal fluid (CSF) in the diagnosis of bacterial meningitis.MethodsWe included patients with bacterial meningitis, both community acquired and post neurosurgery. We included two comparison groups: patients with viral meningitis and patients who underwent lumbar punctures for noninfectious indications. We calculated mean differences and 95% confidence intervals of procalcitonin in CSF and plasma in patients with and without bacterial meningitis.ResultsAverage PCT concentrations in CSF were 0.60 ng mL−1 (95% CI: 0.29–0.92) in the bacterial meningitis group (n = 26), 0.81 (95% CI: 0.33–1.28) in community‐acquired meningitis (n = 16) and 0.28 (95% CI: 0.10–0.45) in postneurosurgical meningitis (n = 10), 0.10 ng mL−1 (95% CI: 0.08–0.12) in the viral meningitis group (n = 14) and 0.08 ng mL−1 (95% CI: 0.06–0.09) in the noninfectious group (n = 14). Mean difference of PCT‐CSF between patients with community‐acquired bacterial meningitis and with viral meningitis was 0.71 ng mL−1 (95% CI: 0.17–1.25) and 0.73 ng mL−1 (95% CI: 0.19–1.27) for community‐acquired bacterial meningitis versus the noninfectious group. The median PCT CSF: plasma ratio was 5.18 in postneurosurgical and 0.18 in community‐acquired meningitis (IQR 4.69 vs. 0.28).ConclusionProcalcitonin in CSF was significantly higher in patients with bacterial meningitis when compared with patients with viral or no meningitis. PCT in CSF may be a valuable marker in diagnosing bacterial meningitis, and could become especially useful in patients after neurosurgery.

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Section: Introductionmentioning

confidence: 99%

Procalcitonin in cerebrospinal fluid in meningitis: a prospective diagnostic study

Alons¹,

Verheul²,

Kuipers³

et al. 2016

Brain and Behavior

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“…All prediction models for differentiating bacterial from viral meningitis include a combination of parameters (WBC, PMN, protein, LDH, CRP, lactate, age, month, glucose, etc.) as opposed to one single parameter [2,[15][16][17][18][19][20].…”

Section: Cerebrospinal Fluid (Csf)mentioning

confidence: 99%

Clinical relevance and contemporary methods for counting blood cells in body fluids suspected of inflammatory disease

Fleming

Russcher

Lindemans

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:In many inflammatory diseases, the cellular components in body fluids [cerebrospinal fluid (CSF), serous fluids] are increased, rendering essential diagnostic information. The diagnostic value of the total white blood cell count (WBC) and differential count has been evaluated extensively over the years, and a remarkable amount of knowledge has been gained; yet, there is a great deal of clinical uncertainty whether the diagnosis should be based solely on these variables. In some diseases, such as peritonitis, the total WBC and differential count has high sensitivity; whereas, in differentiating pleural effusions, it lacks the sensitivity required to be clinically useful. Nevertheless, many guidelines consider these tests as cornerstone parameters, and in combination with clinical variables, they can successfully guide clinical decision making in initiating or postponing a treatment course for infection and/or inflammatory diseases while awaiting culture results. Although other methods are available for detecting and differentiating WBCs in body fluids, manual microscopy is still considered the gold standard despite its many limitations. During the last decade, automated analyzers have become a popular method for first line screening. Continued progress in their design has led to major improvements including their speed, improved accuracy and lower variability compared with microscopy. Disadvantages of this method include high imprecision in low ranges (depending on the method) and interfering factors.In a time where automation is at the front line in clinical laboratories, it is essential the results obtained are precise, accurate and reproducible. This review provides an overview of the relevance for cell counting in a variety of diagnostic body fluids, and highlights the current technologies used.

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“…Of these, serum procalcitonin (PCT) and CSF lactate have the most potential to be useful clinically, with performances that are similar to or better than conventional CSF parameters in research studies (34,35). However, both biomarkers are nonspecific and can be affected by prior antibiotic treatment and noninfectious conditions, making it unclear how generalizable these results are to routine clinical practice.…”

Section: Current Diagnostic Test Methodsmentioning

confidence: 99%

State-of-the-Art Microbiologic Testing for Community-Acquired Meningitis and Encephalitis

Polage

Cohen

2016

J Clin Microbiol

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Meningitis and encephalitis are potentially life-threatening diseases with a wide array of infectious, postinfectious, and noninfectious causes. Diagnostic testing is central to determining the underlying etiology, treatment, and prognosis, but many patients remain undiagnosed due to suboptimal testing and lack of tests for all pathogens. In this article, we summarize the epidemiology, barriers to diagnosis, and current best tests for meningitis and encephalitis in developed countries. We end with a brief discussion of new test methods, such as multiplex panel-based tests and metagenomic sequencing, which are likely to alter diagnostic strategies for these conditions in the near future.

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Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis

Cited by 137 publications

References 37 publications

Procalcitonin in cerebrospinal fluid in meningitis: a prospective diagnostic study

Procalcitonin in cerebrospinal fluid in meningitis: a prospective diagnostic study

Clinical relevance and contemporary methods for counting blood cells in body fluids suspected of inflammatory disease

State-of-the-Art Microbiologic Testing for Community-Acquired Meningitis and Encephalitis

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