Pentraxin-3 in central nervous system infections: A promising but limited biomarker?
Year 2025,
Volume: 42 Issue: 4, 388 - 393, 31.12.2025
Berfin Çirkin Doruk
,
Yusuf Önlen
,
Serdar Doğan
,
Tayibe Bal
Abstract
Central nervous system (CNS) infections lead to high morbidity and mortalitty rates, so there is a need for rapid and reliable biomarkers in diagnosis. The aim of this study was to determine the diagnostic value of Pentraxin-3 (PTX3) levels in CNS infections and to compare these with classic parameters. The study included 42 adult patients diagnosed with CNS infection between July 2020 and August 2021. The cerebral spinal fluid (CSF) and serum PTX3 levels were measured with the ELISA method. The findings were compared with clinical and laboratory parameters. The diagnostic performance was evaluated with ROC curve analysis. Bacterial meningitis was diagnosed in 39.0% of the patients, viral encephalitis in 51.2%, tuberculous meningitis in 7.3%, and fungal meningitis in 2.4%. The mortality rate was determined to be 43.9%. The CSF PTX3 levels were found to be higher in the bacterial cases, but with no significant difference between the serum and CSF PTX3 levels (p=0.327). A negative correlation was determined between CSF PTX3 and the Glasgow Coma Score, and a positive correlation between CSF PTX3 and the CSF protein level. In the ROC analyses, the strongest parameters for differentiation of bacterial and aseptic meningitis were seen to be CSF cell count (AUC: 0.888) and PMN percentage (AUC:0.882, while CSF PTX3 (AUC:0.586) and serum PTX3 (AUC:0.561) had the lowest differentiating power. PTX3 can be measured in CNS infections and higher levels are seen in bacterial meningitis cases. However, according to the ROC analysis results the diagnostic power is limited and these parameters lag behind classic CSF parameters. Therefore, PTX3 alone is not sufficient, but when combined with other biomarkers it can contribute to the clinical diagnostic process. The specific contribution of this study is that by evaluating both CSF and serum PTX3 levels simultaneously a relationship was determined between local and systemic inflammation.
Ethical Statement
This study was supported by Hatay Mustafa Kemal University Scientific Research Project Committee (Project number: 20.U.016).
Supporting Institution
Hatay Mustafa Kemal University Scientific Research Project Committee
Project Number
This study was conducted with the permission of Hatay Mustafa Kemal University Faculty of Medicine Clinical Research Ethics Committee numbered 2020/93.
References
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Brindle HE, Choisy M, Christley R, et al. The global burden of central nervous system infections: a modelling study. Front Public Health. 2024;12:1371502. doi:10.3389/fpubh.2024.1371502
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van Zeggeren IE, ter Horst L, Heijst H, Teunissen CE, van de Beek D, Brouwer MC. Neurofilament light chain in central
nervous system infections: a prospective study of diagnostic accuracy. Sci Rep. 2022;12(1):14140.
doi:10.1038/s41598-022-18450-9
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Giuliano S, Flammini S, Giacobbe DR, et al. Role of procalcitonin and C-reactive protein in patients with bacterial
meningitis. Eur J Clin Microbiol Infect Dis. 2022;41(3):387-94. doi:10.1007/s10096-021-04358-8
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Bottazzi B, Inforzato A, Messa M, et al. The pentraxins PTX3 and SAP in innate immunity, regulation of inflammation
and tissue remodelling. J Hepatol. 2016;64(6):1416-27. doi:10.1016/j.jhep.2016.02.029
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Garlanda C, Bottazzi B, Bastone A, Mantovani A. Pentraxins at the crossroads between innate immunity,
inflammation, matrix deposition, and female fertility. Annu Rev Immunol. 2005;23:337-66.
doi:10.1146/annurev.immunol.23.021704.115756
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Bonacina S, Barbieri SS, Cutuli L, et al. Pentraxin 3 in cardiovascular and neuroinflammatory disorders. Front
Immunol. 2022;13:841095. doi:10.3389/fimmu.2022.841095
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Zatta M, Di Pietro A, D'Abramo A, et al. Cerebrospinal fluid pentraxin 3 in patients with meningitis: diagnostic and
prognostic significance. Eur J Clin Microbiol Infect Dis. 2020;39(4):665-70. doi:10.1007/s10096-019-03759-7
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El-Kady H, Mostafa MG, Hassan R, et al. Cerebrospinal fluid pentraxin 3 as a biomarker for bacterial meningitis in
children. BMC Pediatr. 2025;25(1):7. doi:10.1186/s12887-024-05065-1
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Porte R, Davoudian S, Asgari F, et al. The long pentraxin PTX3 as a key component of humoral innate immunity and
a candidate diagnostic/prognostic biomarker in infectious and inflammatory diseases. Front Immunol.
2019;10:794. doi:10.3389/fimmu.2019.00794
-
Thomsen MM, Munthe-Fog L, Garred P, et al. Pentraxin 3 levels in cerebrospinal fluid as a diagnostic marker of
bacterial meningitis. PLoS One. 2023;18(3):e0282004. doi:10.1371/journal.pone.0282004
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Hamed GM, Megahed NA, Abdelhakeem G, et al. Plasma pentraxin 3 in patients with sepsis: relationship with
severity and outcome. BMC Infect Dis. 2017;17:554. doi:10.1186/s12879-017-2663-0.
Year 2025,
Volume: 42 Issue: 4, 388 - 393, 31.12.2025
Berfin Çirkin Doruk
,
Yusuf Önlen
,
Serdar Doğan
,
Tayibe Bal
Project Number
This study was conducted with the permission of Hatay Mustafa Kemal University Faculty of Medicine Clinical Research Ethics Committee numbered 2020/93.
References
-
Brindle HE, Choisy M, Christley R, et al. The global burden of central nervous system infections: a modelling study. Front Public Health. 2024;12:1371502. doi:10.3389/fpubh.2024.1371502
-
van Zeggeren IE, ter Horst L, Heijst H, Teunissen CE, van de Beek D, Brouwer MC. Neurofilament light chain in central
nervous system infections: a prospective study of diagnostic accuracy. Sci Rep. 2022;12(1):14140.
doi:10.1038/s41598-022-18450-9
-
Giuliano S, Flammini S, Giacobbe DR, et al. Role of procalcitonin and C-reactive protein in patients with bacterial
meningitis. Eur J Clin Microbiol Infect Dis. 2022;41(3):387-94. doi:10.1007/s10096-021-04358-8
-
Bottazzi B, Inforzato A, Messa M, et al. The pentraxins PTX3 and SAP in innate immunity, regulation of inflammation
and tissue remodelling. J Hepatol. 2016;64(6):1416-27. doi:10.1016/j.jhep.2016.02.029
-
Garlanda C, Bottazzi B, Bastone A, Mantovani A. Pentraxins at the crossroads between innate immunity,
inflammation, matrix deposition, and female fertility. Annu Rev Immunol. 2005;23:337-66.
doi:10.1146/annurev.immunol.23.021704.115756
-
Bonacina S, Barbieri SS, Cutuli L, et al. Pentraxin 3 in cardiovascular and neuroinflammatory disorders. Front
Immunol. 2022;13:841095. doi:10.3389/fimmu.2022.841095
-
Zatta M, Di Pietro A, D'Abramo A, et al. Cerebrospinal fluid pentraxin 3 in patients with meningitis: diagnostic and
prognostic significance. Eur J Clin Microbiol Infect Dis. 2020;39(4):665-70. doi:10.1007/s10096-019-03759-7
-
El-Kady H, Mostafa MG, Hassan R, et al. Cerebrospinal fluid pentraxin 3 as a biomarker for bacterial meningitis in
children. BMC Pediatr. 2025;25(1):7. doi:10.1186/s12887-024-05065-1
-
Porte R, Davoudian S, Asgari F, et al. The long pentraxin PTX3 as a key component of humoral innate immunity and
a candidate diagnostic/prognostic biomarker in infectious and inflammatory diseases. Front Immunol.
2019;10:794. doi:10.3389/fimmu.2019.00794
-
Thomsen MM, Munthe-Fog L, Garred P, et al. Pentraxin 3 levels in cerebrospinal fluid as a diagnostic marker of
bacterial meningitis. PLoS One. 2023;18(3):e0282004. doi:10.1371/journal.pone.0282004
-
Hamed GM, Megahed NA, Abdelhakeem G, et al. Plasma pentraxin 3 in patients with sepsis: relationship with
severity and outcome. BMC Infect Dis. 2017;17:554. doi:10.1186/s12879-017-2663-0.