In order to differentiate
bacterial meningitis versus
viral meningitis, we have comparatively tested the efficacy of the following tests:
C-reactive protein (CRP), erythrocytes sedimentation rate (ESR),
fever, level of
glucose in cerebro-spinal fluid (CSF),
glucose in CSF/glycemia ratio, number of white blood cells in peripheric blood, percentage of neutrophils in peripheric blood, level of
proteins in CSF and number of nucleated cells in CSF for a group of 49 patients, both children and adults with
central nervous system infection (37 patients with
bacterial meningitis and 12 with
viral meningitis) hospitalised between May 1993 and July 1994 in Clinical Hospital for
Infectious Diseases in Iaşi. The mean value of CRP in
bacterial meningitis patients was 8.78 mg%, contrasting with the mean value of CRP = 1.92 mg% recorded in patients with
viral meningitis. Ten out of 37
bacterial meningitis patients presented a CRP concentration < 1.85 mg%. All these 10 patients have already had an
antibiotic treatment at the moment of the assay. One out of 12 cases of
viral meningitis had a value of CRP = 3.3 mg%, all the remainder cases having values under 1.85 mg%. We recorded highly significant differences between the two patient groups for CRP (p < 0.001), ESR (p < 0.01),
protein concentration in CSF (p < 0.001) and number of nucleated cells in CSF (p < 0.001). Differences recorded for
fever, concentration of
glucose in CSF,
glucose in CSF/glycemia ratio, number of leucocytes in peripheric blood and percentage of neutrophils in peripheric blood, were not significant (p > 0.5). Data were analysed also by box-plot method which facilitates the visual appraisal of the differences recorded between the two aetiological groups. In conclusion, assays of CRP and ESR may be used as differentiation tests for
bacterial meningitis versus
viral meningitis, when assay is done before the
antibiotic treatment, being sufficient sensitive, and easy to perform.