The serum and cerebrospinal fluid procalcitonin levels and their relationship with acute phase reactants in childhood meningitis

Yıl 2025, Cilt: 30 Sayı: 1, 93 - 101, 29.01.2025

Derya Özmen

https://doi.org/10.21673/anadoluklin.1482772

Öz

Aim: Bacterial meningitis is a paediatric emergency with high mortality and morbidity requiring prompt diagnosis and treatment. It is not always possible to differentiate between viral and bacterial etiology in childhood meningitis and it takes time. In this study, the value of serum and cerebrospinal fluid (CSF) procalcitonin levels in the early diagnosis of bacterial and viral meningitis and their relationship with acute phase indicators were investigated in children examined with a preliminary diagnosis of meningitis.

Methods: Pediatric patients who underwent lumbar puncture (LP) with the preliminary diagnosis of meningitis were included in the study. Serum and CSF procalcitonin levels, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels of these patients were examined.

Results: During the study, 75 patients underwent LP due to suspicion of meningitis. Fifteen patients were diagnosed with bacterial meningitis and 6 patients with viral meningitis. All 7 patients were diagnosed with non-infectious diseases affecting the central nervous system, and this group was used as the control group. There was no significant difference in terms of ESR and CRP levels when the bacterial meningitis group was compared with the viral meningitis group. However, serum and CSF procalcitonin levels were statistically significantly higher in the bacterial group. Serum and CSF procalcitonin levels showed a positive correlation with CSF protein level and CRP level in both bacterial and viral meningitis groups. CSF procalcitonin levels also positively correlated with CSF cell count. The cut-off value between the bacterial meningitis and control groups was found to be 0.61 ng/mL for serum procalcitonin and 0.5 ng/mL for CSF procalcitonin. While no significant limit value could be determined for CSF procalcitonin between the bacterial and viral meningitis groups, the cut-off value for serum procalcitonin was found to be 0.2 ng/mL.

Conclusion: While ESR and CRP levels provide limited information in the distinction between bacterial and viral meningitis, serum and CSF procalcitonin levels may be helpful in this distinction, as they are significantly higher in bacterial meningitis.

Anahtar Kelimeler

Acute phase reactant, meningitis, procalcitonin

Çocukluk çağı menenjitinde serum ve beyin omurilik sıvısı prokalsitonin düzeyleri ve akut faz göstergeleri ile ilişkisi

Öz

Amaç: Bakteriyel menenjit, yüksek mortalite ve morbiditeye sahip, hızlı tanı ve tedavi gerektiren pediatrik acil bir durumdur. Menenjitte viral-bakteriyel etiyoloji ayrımı yapmak her zaman mümkün değildir ve zaman alır. Bu çalışmada menenjit ön tanısı ile tetkik edilen çocuklarda, serum ve beyin omurilik sıvısı (BOS) prokalsitonin düzeylerinin, bakteriyel ve viral menenjitlerin erken tanısındaki yeri ve akut faz göstergeleri ile ilişkisi araştırılmıştır.

Yöntemler: Çalışmaya menenjit ön tanısıyla lomber ponksiyon (LP) yapılan çocuk hastalar alındı. Bu hastaların serum ve BOS prokalsitonin düzeylerine, eritrosit sedimentasyon hızına (ESH) ve C-reaktif protein (CRP) düzeyine bakıldı.

Bulgular: Çalışma sırasında 75 hastaya menenjit şüphesiyle LP yapıldı. 15 hastaya bakteriyel menenjit ve 6 hastaya viral menenjit tanısı konuldu. 7 hastaya da santral sinir sistemini etkileyen enfeksiyon dışı hastalık tanısı konuldu ve bu grup kontrol grubu olarak kullanıldı. Bakteriyel menenjit grubu ile viral menenjit grubu karşılaştırıldığında ESH ve CRP düzeyi açısından anlamlı bir fark yoktu. Fakat serum ve BOS prokalsitonin düzeyleri bakteriyel grupta istatistiksel olarak anlamlı şekilde yüksekti. Serum ve BOS prokalsitonin düzeyleri hem bakteriyel hem de viral menenjit grubunda BOS protein düzeyi ve CRP düzeyi ile pozitif korelasyon gösteriyordu. BOS prokalsitonin düzeyleri ayrıca BOS hücre sayısı ile pozitif korelasyon gösteriyordu. Bakteriyel menenjit ve kontrol grubu arasında sınır değer serum prokalsitonin için 0,61 ng/mL ve BOS prokalsitonin için 0,5 ng/mL olarak bulundu. Bakteriyel ve viral menenjit grupları arasında ise BOS prokalsitonin için anlamlı bir sınır değer tespit edilemezken serum prokalsitonin için sınır değer 0,2 ng/mL olarak bulundu.

Sonuç: Bakteriyel-viral menenjit ayrımında ESH ve CRP düzeyi sınırlı bilgi verirken serum ve BOS prokalsitonin düzeyleri bakteriyel menenjitte anlamlı olarak daha yüksek olduğu için bu ayrımda yardımcı olabilir.

Anahtar Kelimeler

Akut faz reaktanı, menenjit, prokalsitonin

Kaynakça

• Hacımustafaoğlu M. Akut Bakteriyel Menenjit. Türkiye Klinikleri Dergisi Pediatri Özel. 2004;2(3):230-6.
• Haspolat Ş. Santral Sinir Sistemi Enfeksiyonları. Türkiye Klinikleri Dergisi Pediatri Özel. 2003;1(2):154-60.
• Behrman RE, Jenson HB. Central nervous system infections. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Pediatrics, 17th edition. USA: Saunders, 2004;p.2038-44.
• Lindquist L, Linné T, Hansson LO, Kalin M, Axelsson G. Value of cerebrospinal fluid analysis in the differential diagnosis of meningitis: a study in 710 patients with suspected central nervous system infection. Eur J Clin Microbiol Infect Dis. 1988;7(3):374-80.
• Katz SL. Viral infections of the central nervous. In: Gershon AA, Hotez PJ, editors. Krugman’s İnfectious Disease Children. St Louis, MO: CV. Mosby. 1998;p. 650-666.
• Gendrel D, Raymond J, Assicot M, et al. Measurement of procalcitonin levels in children with bacterial or viral meningitis. Clin Infect Dis. 1997;24(6):1240-2.
• Schwarz S, Bertram M, Schwab S, Andrassy K, Hacke W. Serum procalcitonin levels in bacterial and abacterial meningitis. Crit Care Med. 2000;28(6):1828-32.
• Carrol ED, Newland P, Riordan FA, Thomson AP, Curtis N, Hart CA. Procalcitonin as a diagnostic marker of meningococcal disease in children presenting with fever and a rash. Arch Dis Child. 2002;86(4):282-5.
• Dubos F, Moulin F, Gajdos V, et al. Serum procalcitonin and other biologic markers to distinguish between bacterial and aseptic meningitis. J Pediatr. 2006;149(1):72-6.
• Taskin E, Turgut M, Kilic M, Akbulut H, Aygun AD. Serum procalcitonin and cerebrospinal fluid cytokines level in children with meningitis. Mediators Inflamm. 2004;13(4):269-73.
• Prat C, Domínguez J, Rodrigo C, et al. Use of quantitative and semiquantitative procalcitonin measurements to identify children with sepsis and meningitis. Eur J Clin Microbiol Infect Dis. 2004;23(2):136-8.
• Hatherill M, Tibby SM, Sykes K, Turner C, Murdoch IA. Diagnostic markers of infection: comparison of procalcitonin with C reactive protein and leucocyte count. Arch Dis Child. 1999;81(5):417-21.
• Mills GD, Lala H, Oehley MR, et al. Elevated procalcitonin as a diagnostic marker in meningococcal disease. Eur J Clin Microbiol Infect Dis. 2006;25(8):501-9.
• Lacour AG, Gervaix A, Zamora SA, et al. Procalcitonin, IL-6, IL-8, IL-1 receptor antagonist and C-reactive protein as identificators of serious bacterial infections in children with fever without localising signs. Eur J Pediatr. 2001;160(2):95-100.
• Fernández Lopez A, Luaces Cubells C, García García JJ, Fernández Pou J; Spanish Society of Pediatric Emergencies. Procalcitonin in pediatric emergency departments for the early diagnosis of invasive bacterial infections in febrile infants: results of a multicenter study and utility of a rapid qualitative test for this marker. Pediatr Infect Dis J. 2003;22(10):895-903.
• Gendrel D, Coste J, Moulin F, et al. Comparison of procalcitonin with C-reactive protein, interleukin 6 and interferon-alpha for differentiation of bacterial vs. viral infections. Pediatr Infect Dis J. 1999;18(10):875-81.
• Somech R, Zakuth V, Assia A, Jurgenson U, Spirer Z. Procalcitonin correlates with C-reactive protein as an acute-phase reactant in pediatric patients. Isr Med Assoc J. 2000;2(2):147-50.
• Julián-Jiménez A, Morales-Casado MI. Usefulness of blood and cerebrospinal fluid laboratory testing to predict bacterial meningitis in the emergency department. Neurologia (Engl Ed). 2019;34(2):105-13.
• Konstantinidis T, Cassimos D, Gioka T, et al. Can Procalcitonin in Cerebrospinal Fluid be a Diagnostic Tool for Meningitis?. J Clin Lab Anal. 2015;29(3):169-74.
• Ahmed MA, Askar GA, Farghaly HS, et al. Accuracy of Cerebrospinal Fluid C-Reactive Protein and Multiplex Polymerase Chain Reaction and Serum Procalcitonin in Diagnosis of Bacterial and Viral Meningitis in Children. Acta Neurol Taiwan. 2022;31(2):61-71.
• Shokrollahi MR, Shabanzadeh K, Noorbakhsh S, Tabatabaei A, Movahedi Z, Shamshiri AR. Diagnostic Value of CRP, Procalcitonin, and Ferritin Levels in Cerebrospinal Fluid of Children with Meningitis. Cent Nerv Syst Agents Med Chem. 2018;18(1):58-62.
• Zhang L, Ma L, Zhou X, et al. Diagnostic Value of Procalcitonin for Bacterial Meningitis in Children: A Comparison Analysis Between Serum and Cerebrospinal Fluid Procalcitonin Levels. Clin Pediatr (Phila). 2019;58(2):159-65.
• Santotoribio JD, Cuadros-Muñoz JF, García-Casares N. Comparison of C Reactive Protein and Procalcitonin Levels in Cerebrospinal Fluid and Serum to Differentiate Bacterial from Viral Meningitis. Ann Clin Lab Sci. 2018;48(4):506-10.
• Kim H, Roh YH, Yoon SH. Blood Procalcitonin Level as a Diagnostic Marker of Pediatric Bacterial Meningitis: A Systematic Review and Meta-Analysis. Diagnostics (Basel). 2021;11(5):846.
• Chaudhary S, Bhatta NK, Lamsal M, Chaudhari RK, Khanal B. Serum procalcitonin in bacterial & non-bacterial meningitis in children. BMC Pediatr. 2018;18(1):342.
• El Shorbagy HH, Barseem NF, Abdelghani WE, et al. The value of serum procalcitonin in acute meningitis in children. J Clin Neurosci. 2018;56:28-33.
• Alkholi UM, Abd Al-Monem N, Abd El-Azim AA, Sultan MH. Serum procalcitonin in viral and bacterial meningitis. J Glob Infect Dis. 2011;3(1):14-8.
• Mintegi S, García S, Martín MJ, et al. Clinical Prediction Rule for Distinguishing Bacterial From Aseptic Meningitis. Pediatrics. 2020;146(3):e20201126.
• Umran RM, Radhi NH. Diagnostic value of serum procalcitonin level in differentiating bacterial from nonbacterial meningitis in children. Iran J Pediatr. 2014;24(6):739-44.
• Wu J, Shi T, Yue Y, et al. Development a prediction model for identifying bacterial meningitis in young infants aged 29-90 days: a retrospective analysis. BMC Pediatr. 2023;23(1):69.
• Sanaei Dashti A, Alizadeh S, Karimi A, Khalifeh M, Shoja SA. Diagnostic value of lactate, procalcitonin, ferritin, serum-C-reactive protein, and other biomarkers in bacterial and viral meningitis: A cross-sectional study. Medicine (Baltimore). 2017;96(35):e7637.
• Dubos F, Korczowski B, Aygun DA, et al. Serum procalcitonin level and other biological markers to distinguish between bacterial and aseptic meningitis in children: a European multicenter case cohort study. Arch Pediatr Adolesc Med. 2008;162(12):1157-63.
• Ibrahim KA, Abdel-Wahab AA, Ibrahim AS. Diagnostic value of serum procalcitonin levels in children with meningitis: a comparison with blood leukocyte count and C-reactive protein. J Pak Med Assoc. 2011;61(4):346-51.