title: C-reactive protein is useful in distinguishing Gram stain-negative bacterial meningitis from viral meningitis in children.
abstract: OBJECTIVE
  To clarify to what extent Gram stain-negative bacterial meningitis can be distinguished from viral meningitis by assessment of cerebrospinal fluid (CSF) and blood indices and serum C-reactive protein (CRP) in children over 3 months of age.
  
  
  METHODS
  Common CSF indices, blood leukocyte counts, and serum CRP values were compared between patients with bacterial meningitis who had a positive CSF bacterial culture but a negative Gram stain and patients with viral meningitis.
  
  
  METHODS
  Three hundred twenty-five consecutive patients with CSF culture-proven bacterial meningitis, for whom Gram stain was negative in 55 cases, and 182 children with proven or presumed viral meningitis.
  
  
  RESULTS
  Significant differences between patients with bacterial and viral meningitis were found in all indices with large overlap in all except serum CRP. In patients with bacterial meningitis, the mean CSF glucose concentration, protein concentration, leukocyte count, blood leukocyte count, and serum CRP were 2.9 mmol/L (52 mg/dL), 1.88 g/L, 4540 x 10(6)/L, 18.0 x 10(9)/L, and 115 mg/L; and in those with viral meningitis, mean values were 3.3 mmol/L (59 mg/dL), 0.52 g/L, 240 x 10(6)/L, 10.6 x 10(9)/L, and <20 mg/L, respectively. Of the tests investigated in this study, only serum CRP was capable of distinguishing Gram stain-negative bacterial meningitis from viral meningitis on admission with high sensitivity (96%), high specificity (93%), and high negative predictive value (99%).
  
  
  CONCLUSIONS
  Exclusion of bacterial meningitis with only the conventional tests is difficult. Combined with careful physical examination and CSF analyses, serum CRP measurement affords substantial aid.
authors.affiliation: Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Sormunen
authors.forename: M J
authors.initials: MJ
authors.lastname: Kallio
authors.forename: T
authors.initials: T
authors.lastname: Kilpi
authors.forename: H
authors.initials: H
authors.lastname: Peltola
mesh_terms: D000293:Adolescent; D000956:Antigens, Viral / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis*; D002555:Cerebrospinal Fluid / Q000382:microbiology / Q000821:virology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D006090:Gram-Negative Bacteria; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D016920:Meningitis, Bacterial / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D008587:Meningitis, Viral / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D011446:Prospective Studies
chemical_list: D000956:Antigens, Viral; D002097:C-Reactive Protein