The Value of C-Reactive Protein in Children with Meningitis

Abstract

A 6-year prospective study was carried out on 339 infants and children with clinical suspicion of meningitis or febrjle convulsion where C-reactive protein (CRP) determination was done for all patients. The patients were divided into four groups. The serum CRP was positive in 16 of 111 children with viral meningitis, in 50 of 65 with culture-proved bacterial meningitis, in 10 of 17 with partially treated meningitis, and in two of 146 with a first attack of febrile convulsion. The test was nonspecific for routine application, and it was not sensitive for the early differentiation of bacterial, viral, and partially treated meningitis although CRP assay may be a useful additional parameter in the differentiation of various types of meningitis.HA Qurtom, QA Al-Salah, MM Lubani, KI Doudin, DC Sharda, AI John, The Value of C-Reactive Protein in Children with Meningitis. 1989; 9(2): 171-174 Readily available quantitative methods to measure C-reactive protein (CRP) have increased interest in this acute phase reactant.1-3 Levels of CRP, which is a normal constituent of plasma produced by hepatocytes, rise in bacterial but not in viral meningitis. 4,5 In this report we present our findings of CRP in 339 consecutive infants and children. The aim of this study was to determine whether the serum CRP determination could be helpful to differentiate bacterial from viral meningitis. 6,7 Patients and MethodsThree hundred thirty-nine consecutive infants and children suspected of having meningitis were admitted to the Department of Pediatrics, Farwania and Adan Hospitals, Kuwait, between May 1981 and October 1987.Initially all patients were subjected to a lumbar puncture, and CSF was studied for cells, biochemical analysis, and culture. A blood specimen for CRP estimation, complete blood cell count, an erythrocyte sedimentation rate (Westergren method), and blood culture was collected at the time of diagnosis.The CRP was measured by latex agglutination slide test. An aliquot of the test serum was used, and 1:20, 1:40, and 1:80 dilutions of the sample were made with glycine-buffered saline. Thirty microliters of each solution were placed on a glass slide in separate wells, and 30 μL of anti-CRP antibody-coated latex particles were added to each well. The slide was manually agitated at room temperature for 3 minutes, then examined with the naked eye under indirect incandescent illumination. A positive slide consisted of any visible agglutination of 3 or greater when evaluated in the manner of Newman et al. 8 A negative slide was smooth or slightly agranular with no visible agglutination. A CRP level of 6 mg/L or less was considered normal.Red blood cells and leukocytes in CSF were counted in counting chambers; CSF glucose was analyzed using