This study was designed to evaluate the diagnostic and prognostic role of plasma PCT in management of children with meningitis. The study included 60 children chosen from those admitted to the Emergency Department of Abbaseyah Fever Hospital for suspected meningitis. They were divided into: 20 children (aged 1 month to 12 years) proved to have bacterial meningitis (BM) by positive bacterial cultures, 20 children (aged 6 months to 12 years) were diagnosed as aseptic meningitis (ASM) and 20 children (aged 3 months to 14 years) were suspected to have meningitis but their CSF analysis was free, those, were considered as a control group. Blood and CSF samples were taken at time of admission for determination of CSF parameters (cytology, protein, glucose, chloride and ferritin) and blood parameters (erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) and plasma PCT). Plasma PCT and CSF ferritin determination was repeated 7 days after starting treatment of BM cases.
Children with BM had markedly elevated plasma PCT, serum CRP and CSF ferritin levels in comparison with ASM and control children. Treatment significantly lowered the levels of PCT & ferritin (P<0.05). Admission plasma PCT mean level was significantly higher (P<0.05) in children with BM (mean ± SD 17.8 ± 7.3 ng / ml), compared to those with ASM (3.6 ± 1.32), with controls (2.86 ± 1.4) and with post-treatment BM cases (2.91 ± 1.3). Admission CSF ferritin mean level was also significantly higher (P<0.05) in children with BM (mean±SD: 89.8±23 ng/ml), compared those with ASM (11.3±3.45), with controls (9.5±3.06) and with post-treatment BM cases (39. 4±24.3).
Pre-treatment plasma PCT showed a positive significant correlation with both CRP and CSF ferritin levels in BM. Plasma PCT levels could differentiate between pre-treatment BM and ASM with a sensitivity rate and negative predictive value (NPV) of 100%, specificity rate of 95%, positive predictive value (PPV) was 91% and accuracy rate was 96.7%.
It could be concluded that estimation of plasma PCT could be considered as a non-invasive modality for diagnosis and differentiation of cases with septic meningitis and for follow-up to evaluate the response to treatment.