To: Robert K. who wrote (10641 ) 7/7/1999 8:59:00 PM From: Tharos Respond to of 17367
C-REACTIVE PROTEIN TEST DIFFERENTIATES VIRAL AND GRAM-NEGATIVE BACTERIAL MENINGITISid.medscape.com WESTPORT, Jun 30 (Reuters Health) - Serum C-reactive protein levels reliably distinguish between Gram stain-negative bacterial meningitis and viral meningitis in children, according to results published in the Journal of Pediatrics for June. Dr. Paivi Sormunen and colleagues, from Helsinki University Central Hospital in Finland, compared the following measures for 55 children with Gram-negative, culture-positive bacterial meningitis and 182 children with presumed or proven viral meningitis: cerebrospinal fluid glucose, protein, and leukocyte counts; peripheral leukocyte count; and serum C-reactive protein level. "Significant differences were found between results in patients with bacterial meningitis and those with viral meningitis in all tests, but considerable overlapping values were found in all tests except measurement of serum [C-reactive protein]," Dr. Sormunen's team reports. The research team determined that "...in 93% of [viral meningitis] patients the [C-reactive protein] value was within the normal range (<20 mg/L)." The highest value reported in this group was 40 mg/L. In contrast, only two children with Gram-negative bacterial meningitis had [C-reactive protein] levels <20 mg/L. C-reactive protein measurement was especially helpful in clarifying conflicting laboratory results. Seven children with Gram-negative bacterial meningitis had cerebrospinal fluid findings "...indicative of viral meningitis," the researchers report, but "...all 7 children had serum [C-reactive protein] values elevated above 40 mg/L." The authors found that C-reactive protein measurement "...was capable of distinguishing Gram-negative bacterial meningitis from viral meningitis with high sensitivity (96%), high specificity (93%), and high negative predictive value (99%) in children over 3 months of age. Performance of no other laboratory tests reached these levels." Based on these findings and on the test's rapid turnaround time, Dr. Sormunen's group recommends that C-reactive protein measurement be added to the armamentarium for distinguishing viral from bacterial meningitis. Measurement of serum C-reactive protein "...affords substantial aid in management of meningitis and could limit unnecessary use of antimicrobial agents in many patients with viral meningitis," Dr. Sormunen and associates conclude. J Pediatr 1999;134:724-729.