Affiliations: Department of Pediatric Infectious Diseases, Saratov
State Medical University, Saratov, Russia | Department of Microbiology, Virology and Immunology,
Saratov State Medical University, Saratov, Russia
Note: [] Correspondence: Aleksandra V. Steinberg, Department of Pediatric
Infectious Diseases, Saratov State Medical University, Rahova 98/106-29,
Saratov, Russia, 410056. Tel.: +7 9276 223501; Fax: +7 8452 669772; E-mail:
aleksa.steinberg@gmail.com
Abstract: All over the world, meningitis remains one of the most widespread
neuroinfections for adults and children. Successful initiation of treatment and
prognosis depends on rapid diagnosis. Diagnosis begins with a clear
differentiation between bacterial and viral characteristics of the causative
agent. The aim of our research was to optimize the diagnostic procedure used in
Russian infectious diseases hospitals for children with preliminary diagnosis
of "meningitis". There were 232 patients (1 to 14 years of age) hospitalized
and observed in our Saratov State children infectious hospital with preliminary
diagnosis of "meningitis." Diagnoses occurred on day 2.2 ± 0.7 from
onset of illness. It was impossible to differentiate bacterial or viral
etiology of meningitis on the basis of clinical observation or results of
common laboratory assays (mixed pleocytosis in analysis) cerebrospinal fluid
(CSF). The results of our research of these "acute phase of inflammation
proteins" demonstrate that patients with bacterial meningitis have serum
C-reactive protein (CRP) levels higher than 24 mg/L (42.2 ± 5.1 mg/L,
normal 0 mg/L), liquor CSF lactoferrin content – higher than 135.0 ng/L
(342.6 ± 14.2 ng/L; normal 6.39 ± 1.7 ng/L), serum procalcitonin
(PCT) level – higher than 0.5 ng/mL. Patients with "viral meningitis"
have serum CRP levels lower than 18.0 mg/L (9.8 ± 1.1 mg/L, normal 0
mg/L), liquor CSF lactoferrin content – lower than 120.0 ng/L (61.9
± 7.8 ng/L, normal 6.39 ± 1.7 ng/L), serum PCT level –
lower than 0.5 ng/mL. For patients with "intermediate level" of CRP in their
serum samples (18.0–24.0 mg/L) or lactoferrin in their CSF samples
(120.0–135.0 ng/L) test on serum PCT content is highly recommended
because in all cases gives unambiguous results.
Keywords: Meningitis, enterovirus, coxsackieviruses, echoviruses, children
