[Procalcitonin, C-reactive protein and interleukin 6 in bacterial and viral meningitis in children].
OBJECTIVE
In young children with meningitis, blood or cerebrospinal fluid (CSF) analysis cannot differentiate all cases of viral meningitis (VM) from bacterial meningitis (BM). Empirical antibiotic therapy is often given. As new markers are needed, we compared serum proCalcitonin (PCT) with CSF analysis for C-reactive protein (CRP) and interleukin-6 (IL6).


METHODS
PCT was measured with a chemoluminescent assay in the sera of 23 children (aged 3 months to 14 years) hospitalized for BM and in 51 patients with VM.


RESULTS
Initial CRP (mean 143.3 mg/l, range 28-351 and mean 13.9, range 1-48), CSF proteins (mean 2.2, range 0.4-4.74 and mean 0.57, range 0.12-2.72) and white blood cell count in CSF (range 240-17500 and 20-3200) in BM and VM respectively, were not sufficiently discriminative to distinguish between BM and VM. Twenty-four of the 51 patients with VM were given antibiotics. IL6 values at admission showed an overlap zone (> 100 pg/ml in 7/19 patients with VM and < 100 pg/ml in 1/8 patients with BM. PCT was discriminative in all cases: mean PCT in BM was 61 micrograms/l (range 4.8-335) and 0.33 in VM (range 0-1.7; p < 0.001). No production of PCT was detected in CSF. After antibiotic therapy, PCT decreased and reached undetectable levels after recovery.


CONCLUSIONS
PCT is a sensitive and specific marker for early diagnosis of viral meningitis versus bacterial meningitis in children.
Hopital Saint Vincent-de-Paul, Paris.
D
D
Gendrel
J
J
Raymond
M
M
Assicot
S
S
Avenel
H
H
Lefèvre
S
S
Ravilly
F
F
Moulin
C
C
Lacombe
P
P
Palmer
P
P
Lebon
C
C
Bohuon
D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D015850:Interleukin-6 / Q000097:blood*; D016920:Meningitis, Bacterial / Q000097:blood*; D008587:Meningitis, Viral / Q000097:blood*; D011498:Protein Precursors / Q000097:blood*; D012016:Reference Values
D015415:Biomarkers; C000606589:CALCA protein, human; D015850:Interleukin-6; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
Procalcitonine, protéine C-réactive et interleukine 6 dans les méningites bactériennes et virales de l'enfant.