Significance of c reactive protein (CRP) in meningitis- a prospective observational study

Abstract

Introduction: Meningitis, which is potentially a serious problem among all age groups. This may progress to severe and permanent neurological deficits and even death too. Various parameters are used to diagnose and differentiate among meningitis. C reactive protein may be one of them.

Aims and objectives: To establish the significance of CSF as well as serum CRP in diagnosing and differentiating pyogenic and tubercular meningitis.

Method: Prospective observational study conducted in Govt. medical college, Kota. Age and sex matched 100 patients (40 0f pyogenic meningitis, 40 of tubercular meningitis & 20 as control) were included. Serum and CSF CRP was estimated.

Results: The incidence of tubercular and bacterial meningitis was maximum in adult age group (56% and 52% respectively). CT Scan of head showed abnormalities in 40% cases of tubercular meningitis as compared to 20% cases of pyogenic meningitis. In adults sensitivity of Serum CRP in pyogenic meningitis is 100% and in tubercular meningitis 93.75%. Specificity of Serum CRP was 64.28% in both groups. Sensitivity of CSF-CRP in pyogenic meningitis is 17.65% and tubercular meningitis is 18.75%. Specificity in both the conditions is 92.86%. Predictive value of positive CSF-CRP in both groups is 75%.

Serum CRP was statistically significant in both pyogenic (p<0.004) and tubercular meningitis (p<0.002) in comparison with control group. CSF-CRP was not significantly raised as compared to controls.

Conclusion: There is a significant correlation between CSF-CRP and serum CRP in pyogenic meningitis in pediatric age group. In adult age group, no significant correlation between serum and CSF-CRP levels in pyogenic meningitis cases was found. Hence restricting its role in the diagnosis in adults population. In tubercular meningitis both serum and CSF-CRP levels estimation could not achieve statistical significance in both the age groups.

Key words: C reactive protein; Pyogenic meningitis; Tubercular meningitis