title: Serum procalcitonin levels in bacterial and abacterial meningitis.
abstract: OBJECTIVE
  To test the hypothesis that serum procalcitonin (PCT) levels are elevated in patients with bacterial meningitis and remain within normal limits in patients with abacterial meningitis.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  A total of 30 patients (13 men and 17 women) with a mean age of 52 yrs, having acute bacterial (n = 16) or abacterial (n = 14) meningitis.
  
  
  METHODS
  Blood and cerebrospinal fluid samples.
  
  
  RESULTS
  Patients with abacterial meningitis were younger and had a shorter hospital stay. Of 16 patients with bacterial meningitis, 14 were in a septic condition at admission, but only 5 of 14 patients with abacterial meningitis were in a septic condition at admission. At discharge, 12 patients were without symptoms, 9 patients were moderately disabled, and 9 were severely disabled. No patient died. At admission, PCT, C-reactive protein, white blood cell and cerebrospinal fluid leukocyte counts, and cerebrospinal fluid protein and lactate levels were higher and the serum/cerebrospinal fluid glucose quotient was lower in patients with bacterial meningitis as compared with those with abacterial meningitis (p < .001). PCT was the variable with the highest specificity for bacterial infections (100%), but there were false-negative findings in five patients with bacterial meningitis (a sensitivity of 69%). Persistently elevated or increasing PCT levels after 2 days were associated with an unfavorable clinical course.
  
  
  CONCLUSIONS
  Our results indicate that PCT is a useful additional variable for distinguishing bacterial from abacterial meningitis. In patients with abacterial meningitis, PCT levels do not increase even in cases of viral sepsis. Elevated PCT levels indicate a bacterial origin with high specificity, but false-negative results can occur.
authors.affiliation: Department of Neurology, University of Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schwarz
authors.forename: M
authors.initials: M
authors.lastname: Bertram
authors.forename: S
authors.initials: S
authors.lastname: Schwab
authors.forename: K
authors.initials: K
authors.lastname: Andrassy
authors.forename: W
authors.initials: W
authors.lastname: Hacke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006023:Glycoproteins / Q000097:blood*; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000097:blood*; D008875:Middle Aged; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012680:Sensitivity and Specificity
chemical_list: C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide