title: Usefulness of inflammatory biomarkers in discriminating between bacterial and aseptic meningitis in hospitalized children from a population with low vaccination coverage.
abstract: BACKGROUND
  Neisseria meningitidis and Streptococcus pneumoniae are the most frequent pathogens responsible for meningitis beyond the neonatal period. Aseptic meningitis is a disabling condition, but bacterial meningitis if left untreated is 100% fatal. The aim of the study was to analyze the usefulness of biochemical and hematological parameters in distinguishing between bacterial and non-bacterial meningitis in children with meningitis from a population with low rates of vaccination against S. pneumoniae and N. meningitidis.
  
  
  METHODS
  This study is a retrospective chart review of children hospitalized with meningitis. In patients with aseptic and bacterial meningitis the following parameters were compared: C-reactive protein, D-dimers, fibrinogen, glucose level, and leukocyte level, and in cerebrospinal fluid, protein, glucose, and leukocyte concentrations were analyzed. Number of points in the Bacterial Meningitis Score (BMS) was calculated. The predictive value of each parameter to distinguish between bacterial and aseptic meningitis was evaluated.
  
  
  RESULTS
  In total, 129 patients were included in the study: 65 diagnosed with bacterial meningitis and 64 with aseptic meningitis. Bacterial and aseptic meningitis were statistically significantly different based on each analyzed parameter (p < 0.000001). Among children with aseptic meningitis 42 (66%) scored 0 points in the BMS, while all the children with bacterial meningitis had at least one point.
  
  
  CONCLUSIONS
  In children with meningitis inflammatory biomarkers differ statistically significantly depending on the etiology - bacterial or aseptic. Serum concentration of C-reactive protein higher than 80 mg/dl is a useful marker of bacterial etiology of meningitis. A high Bacterial Meningitis Score is indicative for bacterial meningitis.
authors.affiliation: Department of Family Medicine, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Ewelina
authors.initials: E
authors.lastname: Gowin
authors.affiliation: Department of Health Promotion, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Wysocki
authors.affiliation: Family Medicine Department, University of Ghent, Ghent, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Avonts
authors.affiliation: Department of Molecular Pathology, Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland; Department of Oncology, Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland; Department of Medical Diagnostic, Poznan, Poland.
authors.forename: Danuta
authors.initials: D
authors.lastname: Januszkiewicz-Lewandowska
authors.affiliation: Department of Biostatistics, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Michalak
keywords: C-reactive protein; aseptic meningitis; bacterial meningitis; neuroinfection