[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent].
Despite breakthroughs in the diagnosis and treatment of infectious diseases, meningitis still remains an important cause of mortality and morbidity. An accurate and rapid diagnosis of acute bacterial meningitis is essential for a good outcome. The gold-standard test for diagnosis is CSF analysis. Gram staining of CSF reveals bacteria in about 50 to 80 % of cases and cultures are positive in at best 80 % of cases. However, the sensitivity of both tests is less than 50 % in patients who are already on antibiotic treatment. CSF leukocyte count and concentration of protein and glucose lack specificity and sensitivity for the diagnosis of meningitis. Other biological tests are available for the diagnosis. Latex agglutination test were adapted for rapid and direct detection of soluble bacterial antigens in CSF of patients suspected with bacterial meningitis. This test is efficient in detecting antigens of most common central nervous system bateria but lacks sensibility. Furthermore, in the early phases of acute bacterial and viral meningitis, signs and symptoms are often non specific and it is not always possible to make a differential diagnosis. Markers like CRP, procalcitonin, or sTREM-1 may be very useful for the diagnosis and to differentiate between viral and bacterial meningitis. Bacterial meningitis diagnosis and management require various biological tests and a multidisciplinary approach.
Carbonnelle
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Service de microbiologie, hôpital européen Georges Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France. etienne.carbonnelle@egp.aphp.fr
D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D001706:Biopsy; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D006801:Humans; D007841:Latex Fixation Tests; D007958:Leukocyte Count; D008562:Membrane Glycoproteins / Q000097:blood; D016920:Meningitis, Bacterial / Q000097:blood* / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D009345:Neisseria meningitidis / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood; D011971:Receptors, Immunologic / Q000097:blood; D012680:Sensitivity and Specificity; D012867:Skin / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D000073871:Triggering Receptor Expressed on Myeloid Cells-1
D000900:Anti-Bacterial Agents; C000606589:CALCA protein, human; D008562:Membrane Glycoproteins; D011498:Protein Precursors; D011971:Receptors, Immunologic; C408842:TREM1 protein, human; D000073871:Triggering Receptor Expressed on Myeloid Cells-1; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide