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Jul22
VALIDITY OF CEREBROSPINAL FLUID AND SERUM C-REACTIVE PROTEIN (CRP) IN DIAGNOSIS OF MENINGITIS IN ADULTS
AIM OF THE STUDY:
Validity of C.S.F. and Serum CRP in the diagnosis of meningitis in adults.

MATERIALS AND METHODS:
Fifty cases of meningitis were taken for study in the Department of Medicine form June 2004 to May 2006. Detailed clinical history, physical examinations and routine laboratory investigations were done including mandatory serum and CSF CRP estimation by semi-quantitative method. Clinical diagnosis of pyogenic (bacterial) and TB meningitis (TBM) was determined by history, physical examination, Routine CBC, CSF cytological and biochemical studies.

OBSERVATION AND DISCUSSION:
Out of 50 cases of meningitis 58% were males, 42% were females. Among the bacterial meningitis group maximum number of cases 8 (53.3%) were adults (26-40 years) and in TBM maximum number of cases 12 (37.5%) are in the age group 26-40 years. Fever and headache were the commonest symptoms in all type of meningitis (100%). Meningeal signs were more marked in bacterial (100%) than in TBM (62.5%) and viral cases. Majority of bacterial meningitis were conscious well oriented (66.6%) or at best confused (20%). Altered level of consciousness was more common among TBM cases (87.5%). CSF cell count in pyogenic meningitis varied from 2000/cmm to 63/cmm and 11(73.3%) cases were predominantly polymorphic whereas 4(26.6%) were dimorphic. Among 32 TBM cases the cell count varied from 150/cmm to 20/cmm . 6(18.7%) were dimorphic and rest 26 (81.25%) were predominantly mononuclear. CSF sugar level was reduced more in bacterial meningitis (<20mg/dl) than in TBM cases whereas it was nearly normal in cases of viral meningitis. The CSF protein levels both in bacterial and TBM are high (> 100 mg/dl) whereas it was nearly normal in viral meningitis. The CSF CRP test was positive in 14 (93.3%) out of 15 bacterial meningitis and 2(6.25%) out of 32 cases of TBM. Serum CRP test was positive in all cases of bacterial and tubercular meningitis (100%).

Type of Meningitis No. of Cases Positive serum CRP Positive CSF - CRP
Bacterial meningitis 15(30%) 15(100%) 14(93.3%)
TB meningitis 32(64%) 32(100%) 2(6.25%)
Viral Meningitis 3(6%) - -
Total 50 47 16

CONCLUSION:

Clinical features, cytological and biochemical study of CSF did not differentiate accurately pyogenic from TBM. It was observed that CSFCRP test was positive in almost all cases of bacterial and partially treated bacterial meningitis. The serum CRP test did not discriminate different meningitis whereas CSF CRP positive indicates pyogenic meningitis with greater validity and CSF CRP negatitivity validates tubercular meningitis


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