Microbial aspects and potential markers for differentiation between bacterial and viral meningitis among adult patients

PLoS One. 2021 Jun 11;16(6):e0251518. doi: 10.1371/journal.pone.0251518. eCollection 2021.

Abstract

Objectives: Meningitis is a medical emergency with permanent disabilities and high mortality worldwide. We aimed to determine causative microorganisms and potential markers for differentiation between bacterial and viral meningitis.

Methodology: Adult patients with acute meningitis were subjected to lumber puncture. Cerebrospinal fluid (CSF) microorganisms were identified using Real-time PCR. PCT and CRP levels, peripheral and CSF-leucocyte count, CSF-protein and CSF-glucose levels were assessed.

Results: Out of 80 patients, infectious meningitis was confirmed in 75 cases; 38 cases were bacterial meningitis, 34 cases were viral meningitis and three cases were mixed infection. Higher PCT, peripheral and CSF-leukocytosis, higher CSF-protein and lower CSF-glucose levels were more significant in bacterial than viral meningitis patients. Neisseria meningitides was the most frequent bacteria and varicella-zoster virus was the most common virus. Using ROC analyses, serum PCT and CSF-parameters can discriminate bacterial from viral meningitis. Combined ROC analyses of PCT and CSF-protein significantly improved the effectiveness in predicting bacterial meningitis (AUC of 0.998, 100%sensitivity and 97.1%specificity) than each parameter alone (AUC of 0.951 for PCT and 0.996 for CSF-protein).

Conclusion: CSF-protein and serum PCT are considered as potential markers for differentiating bacterial from viral meningitis and their combination improved their predictive accuracy to bacterial meningitis.

MeSH terms

  • Adult
  • Biomarkers / cerebrospinal fluid
  • Diagnosis, Differential
  • Female
  • Humans
  • Male
  • Meningitis, Bacterial / cerebrospinal fluid
  • Meningitis, Bacterial / diagnosis*
  • Meningitis, Viral / cerebrospinal fluid
  • Meningitis, Viral / diagnosis*

Substances

  • Biomarkers

Grants and funding

The author(s) received no specific funding for this work.