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International Journal of Infectious Diseases: Volume 3, Number 2
Etiology of Central Nervous System Infections in the Philippines and the Role of Serum C-Reactive Protein in Excluding Acute Bacterial Meningitis
Jussi Sutinen, MD; Lydia Sombrero, RMT; Fem Julia E. Paladin, MSc; Ilkka Julkunen, MD; Pauli Leinikki, MD; Elfleda Hernandez, MD; Mediadora Saniel, MD; Dey Brato, MD; and Petri Ruutu, MD

Int J Infect Dis 1999; 3:88-93.

Objectives: The value of measurements of serum C-reactive protein (CRP) in differentiating central nervous system (CNS) infections of varying etiologies in the Philippines was investigated. Methods: A wide array of bacteriologic and virologic methods as well as computed tomography, typical clinical presentation, and autopsy were used for etiologic diagnosis. Results: Among 103 patients with CNS infection, etiology was identified in 60 (58%) cases. Bacteria were found in 19 (including 7 Streptococcus pneumoniae, 5 Haemophilus influenzae, 3 Neisseria meningitidis), tuberculosis in 4, viruses in 38 (including 20 coxsackievirus, 8 measles, 4 adenovirus, and 4 poliovirus infections), and brain abscess in 3 patients. C-reactive protein was elevated on admission in all 18 cases of bacterial meningitis tested, exceeding 50 mg/L in 17 (94%), and was not affected by prior antibacterial treatment. The mean CRP was significantly higher in the bacterial group than in the viral group (207 +/- 111 mg/L vs. 39 +/- 34 mg/L; P < 0.001). In the viral group one third had CRP above 50 mg/L. In patients with tuberculous meningitis, brain abscess, or cryptococcal meningitis, CRP was moderately to highly elevated. Conclusions: In the presence of a normal CRP concentration (below 10 mg/mL) acute bacterial meningitis is excluded even in a developing country setting and antimicrobial therapy is not warranted.

KEYWORDS:CNS infection, C-reactive protein, developing country, diagnostics, etiology

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