The Significance of Serum C-Reactive Protein Estimation in Acute Meningitis in Adults

Gowri Shankar, K (2007) The Significance of Serum C-Reactive Protein Estimation in Acute Meningitis in Adults. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: The evolution of clinical signs and symptoms produced by meningitis or encephalitis varies greatly. Few conditions in medicine require as rapid and accurate therapeutic intervention as acute pyogenic meningitis and viral meningitis, yet meningitis can also occur in chronic and recurrent forms. The major problem presented by patients with meningitis is rapid determination of its aetiology, the specific basis on which selection of potentially effective antimicrobial therapy is predicted. Thus, the clinician must sort out the form of clinical presentation, assess the rapidity of its evolution, and make a specific aetiological diagnosis. The examination of cerebrospinal fluid is an essential and often critical tool in the evaluation and management of patients with meningitis. If interpreted carefully, the cerebrospinal fluid (CSF) analysis, can be very helpful in guiding the diagnostic evaluation and management of patients. Although examination of a Gram’s stain of spinal fluid often defines the causative agent, this is not always the case. Cultures have the draw back of the time required, 24 to 48 hours or more to become positive, an unacceptable delay in initiating the treatment. AIM OF THE STUDY: To evaluate the efficacy of serum C-Reactive Protein in differentiating bacterial meningitis from viral meningitis. MATERIALS AND METHODS: Fifty cases with definite clinical signs and symptoms of acute meningitis admitted in Govt. Stanley Hospital, Chennai during the period August 2005 to September 2006 were taken up for the study. The results were correlated with the results of S-CRP levels and the cases were differentiated into bacterial meningitis or meningitis due to other causes. Inclusion Criteria: 1. Above 12 years of age. 2. History suggestive of meningitis. 3. Neck Rigidity. CONCLUSION: 1. Estimation of C-reactive protein in serum is the cheapest, sensitive and specific test to differentiate bacterial from viral infections. 2. It is a simple qualitative as well as quantitative test and can be done as a bed side investigation. 3. With serum C-reactive protein, a definite aetiological diagnosis can be made rapidly at the time of admission itself. 4. A serum CRP level of less that 6 mg/l with clinical signs of meningeal infection is a definite indicator of viral meningitis. 5. A serum CRP level of more than 48 mg/l with clinical signs of meningeal infection is a definite indication of bacterial meningitis. 6. Preadmission treatment with steroids cause a fall in CRP levels in bacterial meningitis. 7. Serum CRP has 68% predictive value in adults. 8. The rapid differentiation facilitates an early, accurate and appropriate therapy thereby reducing the morality and morbidity rates, the overall cost of the treatment and the duration of hospitalization. 9. Serum CRP can be used as the best and most sensitive bedside prognostic indicator of bacterial infections. 10. Meningeal infections have a definite male predominance. 11. Altered level of consciousness at the time of admission is associated with bad prognosis and high case fatality rate (28%). 12. Fever is the commonest presenting feature followed by altered sensorium, symptoms of increased intracranial tension and seizure. Among neurological deficits, hemiparesis, VIth cranial nerve palsy and VIIth cranial nerve palsy were found to be common. 13. The earlier the recognition of bacterial meningitis and more rapid the institution of antimicrobial therapy the better the chance of a favourable outcome. 14. Therefore, the serum C-reactive protein estimation is most useful in differentiating bacterial meningitis from viral meningitis, especially for developing countries like India, even in peripheral health centres.

Item Type: Thesis (Masters)
Uncontrolled Keywords: significance ; serum c-reactive protein estimation ; acute meningitis ; adults.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 04:12
Last Modified: 24 Mar 2018 05:34

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