Meningitis in Children Clinical Trial
Official title:
Role of CSF-CRPand Serum Procalcitonin in Differentiation Between Bacterial and Viral Meningitis in Children
Meningitis is one of the major lethal infectious diseases especially for the children in developing countries .It is not always possible and often very difficult to distinguish between bacterial and viral meningitis according to CSF findings, which is not accurate 100% and leads to unnecessary antibiotic usage , So We tried to find a useful 'bedside' decision-making tool, based on laboratory results readily available at the emergency department .
Meningitis, since described first in the year 1805, has been one of the major lethal
infectious diseases especially for the children in developing countries .Bacterial
meningitis, still one of the most life-threatening potentially serious infection worldwide of
high morbidity and mortality, it is more prevalent in children and its timely and early
differentiation from viral meningitis has a huge impact on the treatment of affected patients
with 1.2 million cases per year, resulting in 135 000 deaths.
Case fatality rates for bacterial meningitis range from 4.5% in developed countries to 15-50%
in developing countries.
A further 15-20% of survivors sustain neurological sequelae , Including presistant hearing
loss and neurologic disability.
The mortality from meningitis is close to 100% in untreated individuals and can still be up
to 40% in children who received appropriate antibiotic therapy in developing countries .
Most of these fatalities occur within 72 hours of admission to the hospitals. Neurological
outcome and survival depends largely on damage to central nervous system prior to effective
antimicrobial therapy. Quick diagnosis and effective management is the key to success .
bacterial meningitis commonly caused by N.meningitis , strept.Pneumonia, H.influenza & Group
B streptococci. but viral meningitis caused by Enteroviruses 50% , Herpes viruses ,
respiratory viruses & others itis transmitted by person to person contact through respiratory
secretions or droplets.
Diagnostic dilemma is due to large spectrum of signs and symptoms and majority of children
who report to hospital have already been treated with inadequate doses of antibiotics and
present with atypical features of CSF examination. The only reliable method is bacterial
culture of CSF which is positive only in 30-60% and it requires at least 48-72 hrs to be
positive. Hence, a test that might help to diagnose and differentiate meningitis earliest is
more useful to decrease expensive antibiotic for prolonged duration causing financial burden
to poor parents and lengthening of hospital stay .
Hence this study will be conducted to determine and compare the sensitivity, specificity,
predictive values and likelihood ratios of such laboratory tests used for diagnosing and
differentiating between bacterial and viral meningitis are levels of CRP in CSF and serum
procalcitonin with special reference to CSF-CRP level measured by reagent nephelometric
method by BN prospec seimense, the major advantage of this method is it's rapid easy two
minute reaction time . Serum procalcitonin level for all patient suspected with meningitis
measured by chemilumensce on cobas E411 or by ELISA (enzyme linked immunoassay) using blood
culture and gram stain as gold standard test.
;