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Low sensitivity of procalcitonin in cerebrospinal fluid in adult patients with bacterial meningitis

Aim

To compare the diagnostic accuracy of procalcitonin (PCT) for early diagnosis and the discrimination of bacterial and viral meningitis.

Methods

A prospective, observational study involving 59 adults (25 women, 34 men) who were hospitalized for acute meningitis. The diagnosis of meningitis was based on compatible clinical features and cerebrospinal fluid analysis. At admission the serum and cerebrospinal fluid PCT levels were measured simultaneously with a specific immunoluminometric assay (LUMItest Procalcitonin; BRAHMS Diagnostica, Berlin, Germany). Fifteen patients had bacterial meningitis, 44 viral meningitis, based on the detection of pathogenic bacteria and the analysis of cerebrospinal fluid.

Results

PCT levels in patients with viral meningitis were not significantly different in serum and cerebrospinal fluid (0.20 ± 0.22 ng/ml, resp. 0.22 ± 0.25 ng/ml). PCT levels in patients with bacterial meningitis were higher in serum and cerebrospinal fluid compared with patients with viral meningitis (1.04 ± 1.41 ng/ml, resp. 0.75 ± 0.46 ng/ml, P < 0.0001; resp. P < 0.0005). PCT levels were not statistically different in serum and cerebrospinal fluid in patients with bacterial meningitis. We did not find a correlation between PCT levels and an impaired cerebrospinal fluid-blood barrier. PCT levels were false negative in five patients with bacterial meningitis (sensitivity of 66%). PCT levels were correlated with the number of activating monocytes in cerebrospinal fluid.

Conclusion

PCT is of limited diagnostic value in patients suffering from bacterial meningitis.

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Prucha, M., Adam, P., Dostal, M. et al. Low sensitivity of procalcitonin in cerebrospinal fluid in adult patients with bacterial meningitis. Crit Care 10, P77 (2006). https://doi.org/10.1186/cc4424

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Keywords

  • Public Health
  • Observational Study
  • Adult Patient
  • Meningitis
  • Cerebrospinal Fluid