Predictive Value of Serum Procalcitonin Levels in Children with Bacterial Meningitis at Tishreen University Hospital

International Journal of Medical Science

© 2023 by SSRG - IJMS Journal

Volume 10 Issue 5

Year of Publication : 2023

Authors : Hala Omoum, Faisal Radwan, Ghazal Deeb

10.14445/23939117/IJMS-V10I5P104

How to Cite?

Hala Omoum, Faisal Radwan, Ghazal Deeb, "Predictive Value of Serum Procalcitonin Levels in Children with Bacterial Meningitis at Tishreen University Hospital," SSRG International Journal of Medical Science, vol. 10,  no. 5, pp. 19-27, 2023. Crossref, https://doi.org/10.14445/23939117/IJMS-V10I5P104

Abstract:

Bacterial meningitis in children is associated with high morbidity and mortality worldwide, and one in five survivors may have permanent sequelae. For these reasons, a rapid diagnostic evaluation with near 100% sensitivity is essential for optimizing outcomes in children with suspected bacterial meningitis. This study aimed to evaluate the efficiency of procalcitonin (PCT) in predicting bacterial meningitis in children. Methods: This prospective cohort study included (50) patients aged between 30 days and 12 years, presented with clinical features consistent with meningitis, and a lumbar puncture was performed for all children for whom there is no contraindication, and its parameters were studied. Based on CSF culture and direct cytological examination, there were (20) with bacterial meningitis, including (5) who had been previously treated with antibiotics for less than 3 days, there were also (25) with nonbacterial meningitis, and (5) Lumbar puncture was not performed. Serum procalcitonin and C-reactive protein were measured for all children on admission and then repeated 3 days after initiation of intravenous antibiotic therapy. Results: The mean serum PCT was high in the bacterial meningitis group, even in the presence of prior partial treatment, compared to its mean in the nonbacterial meningitis group (9.23 + 6.12 vs 0.10 + 0.14, p = 0.0001), and decreased significantly after 3 days of treatment in the bacterial meningitis group (0.54 + 0.22, p = 0.0001), PCT on admission was also shown to be more sensitive and specific than CRP in diagnosing bacterial meningitis in children. Conclusion: Procalcitonin is considered one of the most important parameters in the early diagnosis of bacterial meningitis in children.

Keywords:

PCT, Bacterial meningitis, CRP, CSF, Nonbacterial meningitis.

References:

[1] Pediatric Bacterial Meningitis, Medscape, 2019. [Online]. Available: https://emedicine.medscape.com/article/961497-overview
[2] Catherine L. Tacon, and Oliver Flower, “Diagnosis and Management of Bacterial Meningitis in the Paediatric Population: A Review,” Emergency Medicine International, pp. 1-8, 2012.
[CrossRef] [Google Scholar] [Publisher Link]
[3] Lise E. Nigrovic et al., “Clinical Prediction Rule for Identifying Children with Cerebrospinal Fluid Pleocytosis at Very Low Risk on Bacterial Meningitis,” The Journal of the American Medical Association, vol. 297, no. 1, pp. 52-60, 2007.
[CrossRef] [Google Scholar] [Publisher Link]
[4] Allan R. Tunkel et al., “Practice Guidelines for the Management of Bacterial Meningitis,” Clinical Infectious Diseases, vol. 39, no. 9, pp. 1267-1284, 2004.
[CrossRef] [Google Scholar] [Publisher Link]
[5] T.V. Parasuraman, Kathleen Frenia, and Jose Romero, “Enteroviral Meningitis: Cost of Illness and Considerations for the Economic Evaluation of Potential Therapies,” PharmacoEconomics, vol. 19, pp. 3-12, 2001.
[CrossRef] [Google Scholar] [Publisher Link]
[6] Fred D. Haruda, “Meningitis: Viral Versus Bacterial,” Pediatrics, vol. 112, no. 2, pp. 447-448, 2003.
[CrossRef] [Google Scholar] [Publisher Link]
[7] Nathan Kuppermann et al., “Clinical and Hematologic Features Do Not Reliably Identify Children with Unsuspected Meningococcal Disease,” Pediatrics, vol. 103, no. 2, pp. 220-223, 1999.
[CrossRef] [Google Scholar] [Publisher Link]
[8] C. Michelow Ian et al., “Value of Cerebrospinal Fluid Leukocyte Aggregation in Distinguishing the Causes of Meningitis in Children,” The Pediatric Infectious Disease Journal, vol. 19, no. 1, pp. 66-72, 2000.
[Google Scholar] [Publisher Link]
[9] Suzanne Maxson, Mary Jo Lewno, and Gordon E. Schutze, “Clinical Usefulness of Cerebrospinal Fluid Bacterial Antigen Studies,” The Journal of Pediatrics, vol. 125, no. 2, pp. 235-238, 1994.
[CrossRef] [Google Scholar] [Publisher Link]
[10] M.I. Morales Casado et al., “Ability of Procalcitonin to Predict Bacterial Meningitis in the Emergency Department,” Neurología (English Edition), vol. 31, no. 1, pp. 9-17, 2016.
[CrossRef] [Google Scholar] [Publisher Link]
[11] Michael Meisner, “Patho Biochemistry and Clinical Use of Procalcitonin,” Clinica Chimica Acta, vol. 323, no. 1, pp. 17-29, 2002.
[CrossRef] [Google Scholar] [Publisher Link]
[12] Linscheid Philippe et al., “Expression and Secretion of Procalcitonin and Calcitonin Gene-Related Peptide by Adherent Monocytes and by Macrophage-Activated Adipocytes,” Critical Care Medicine, vol. 32, no. 8, pp. 1715-1721, 2004.
[CrossRef] [Google Scholar] [Publisher Link]
[13] Intan Samsudin, and Samuel D. Vasikaran, “Clinical Utility and Measurement of Procalcitonin,” The Clinical Biochemist Reviews, vol. 38, no. 2, pp. 59-68, 2017.
[Google Scholar] [Publisher Link]
[14] Stefan Riedel et al., “Procalcitonin as a Marker for the Detection of Bacteremia and Sepsis in the Emergency Department,” American Journal of Clinical Pathology, vol. 135, no. 2, pp. 182-189, 2011.
[CrossRef] [Google Scholar] [Publisher Link]
[15] Jueseong Lee et al., “The Influencing Factors on Procalcitonin Values in Newborns with Noninfectious Conditions During the First Week of Life,” Korean Journal of Pediatrics, vol. 60, no. 1, pp. 10-16, 2017.
[CrossRef] [Google Scholar] [Publisher Link]
[16] Tim Rowland, Heather Hilliard, and Gavin Barlow, “Procalcitonin: Potential Role in Diagnosis and Management of Sepsis,” Advances in Clinical Chemistry, vol. 68, pp. 71-86, 2015.
[CrossRef] [Google Scholar] [Publisher Link]
[17] Allison B. Chambliss et al., “AACC Guidance Document on the Clinical Use of Procalcitonin,” The Journal of Applied Laboratory Medicine, vol. 8, no. 3, pp. 598-634, 2023.
[CrossRef] [Google Scholar] [Publisher Link]
[18] Dimitrios Velissaris et al., “The Role of Procalcitonin in the Diagnosis of Meningitis: A Literature Review,” Journal of Clinical Medicine, vol. 7, no. 6, pp. 1-15, 2018.
[CrossRef] [Google Scholar] [Publisher Link]
[19] Jens Vikse et al., “The Role of Serum Procalcitonin in the Diagnosis of Bacterial Meningitis in Adults: A Systematic Review and MetaAnalysis,” International Journal of Infectious Diseases, vol. 38, pp. 68-76, 2015.
[CrossRef] [Google Scholar] [Publisher Link]
[20] Heeyeon Kim, Yun-Ho Roh, and Seo-Hee Yoon, “Blood Procalcitonin Level as a Diagnostic Marker of Pediatric Bacterial Meningitis: A Systematic Review and Meta-Analysis,” Diagnostics, vol. 11, no. 5, pp. 846, 2021.
[CrossRef] [Google Scholar] [Publisher Link]
[21] M. Alkholi Usama et al., “Serum Procalcitonin in Viral and Bacterial Meningitis,” Journal of Global Infectious Diseases, vol. 3, no. 1, pp. 14-18, 2011.
[CrossRef] [Google Scholar] [Publisher Link]
[22] Dellinger R. Phillip et al., “Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock,” Critical Care Medicine, vol. 32, pp. 536-555, 2004.
[CrossRef] [Google Scholar] [Publisher Link]
[23] Liliana Simon et al., “Serum Procalcitonin and C-Reactive Protein Levels as Markers of Bacterial Infection: A Systematic Review and Meta-Analysis,” Clinical Infectious Diseases, vol. 39, no. 2, pp. 206-217, 2004.
[CrossRef] [Google Scholar] [Publisher Link]
[24] W. Michael Scheld, “Bacterial Meningitis in the Patient at Risk: Intrinsic Risk Factors and Host Defense Mechanisms,” The American Journal of Medicine, vol. 76, no. 5, pp. 193-207, 1984.
[CrossRef] [Google Scholar] [Publisher Link]
[25] Santiago Mintegi et al., “Clinical Prediction Rule for Distinguishing Bacterial from Aseptic Meningitis,” Pediatrics, vol. 146, no. 3, 2020.
[CrossRef] [Google Scholar] [Publisher Link]
[26] X.F. Zhang et al., “Application Value of Procalcitonin in Patients with Central Nervous System Infection,” European Review for Medical and Pharmacological Sciences, vol. 21, no. 17, pp. 3944-3947, 2017.
[Google Scholar] [Publisher Link]