| Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis. | |
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MedLine Citation:
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PMID: 21645387 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: The objective of this study was to determine the ability of various parameters commonly used for the diagnosis of acute meningitis to differentiate between bacterial and viral meningitis, in adult patients with a negative direct cerebrospinal fluid (CSF) examination. METHODS: This was a prospective study, started in 1997, including all patients admitted to the emergency unit with acute meningitis and a negative direct CSF examination. Serum and CSF samples were taken immediately on admission. The patients were divided into two groups according to the type of meningitis: bacterial (BM; group I) or viral (VM; group II). The CSF parameters investigated were cytology, protein, glucose, and lactate; the serum parameters evaluated were C-reactive protein and procalcitonin. CSF/serum glucose and lactate ratios were also assessed. RESULTS: Of the 254 patients with meningitis with a negative direct CSF examination, 35 had BM and 181, VM. The most highly discriminative parameters for the differential diagnosis of BM proved to be CSF lactate, with a sensitivity of 94%, a specificity of 92%, a negative predictive value of 99%, a positive predictive value of 82% at a diagnostic cut-off level of 3.8 mmol/L (area under the curve (AUC), 0.96; 95% confidence interval (CI), 0.95 to 1), and serum procalcitonin, with a sensitivity of 95%, a specificity of 100%, a negative predictive value of 100%, and a positive predictive value of 97% at a diagnostic cut-off level of 0.28 ng/ml (AUC, 0.99; 95% CI, 0.99 to 1). CONCLUSIONS: Serum procalcitonin and CSF lactate concentrations appear to be the most highly discriminative parameters for the differential diagnosis of BM and VM. |
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Authors:
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Alain Viallon; Nicolas Desseigne; Olivier Marjollet; Albert Birynczyk; Mathieu Belin; Stephane Guyomarch; Jacques Borg; Bruno Pozetto; Jean Claude Bertrand; Fabrice Zeni |
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Publication Detail:
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Type: Journal Article Date: 2011-06-06 |
Journal Detail:
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Title: Critical care (London, England) Volume: 15 ISSN: 1466-609X ISO Abbreviation: Crit Care Publication Date: 2011 |
Date Detail:
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Created Date: 2011-07-27 Completed Date: 2011-11-15 Revised Date: 2012-05-02 |
Medline Journal Info:
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Nlm Unique ID: 9801902 Medline TA: Crit Care Country: England |
Other Details:
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Languages: eng Pagination: R136 Citation Subset: IM |
Affiliation:
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Emergency and Intensive Care Units, North Hospital, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne Cedex 2, France. alain.viallon@chu-st-etienne.fr |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Adolescent Adult Aged Area Under Curve Biological Markers / blood, cerebrospinal fluid C-Reactive Protein / analysis Calcitonin / blood* Cerebrospinal Fluid / chemistry, cytology Cerebrospinal Fluid Proteins / cerebrospinal fluid Diagnosis, Differential Female Glucose / cerebrospinal fluid Humans Lactic Acid / cerebrospinal fluid* Male Meningitis, Bacterial / blood, cerebrospinal fluid, diagnosis* Meningitis, Viral / blood, cerebrospinal fluid, diagnosis* Middle Aged Prospective Studies Protein Precursors / blood* Sensitivity and Specificity Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Cerebrospinal Fluid Proteins; 0/Protein Precursors; 50-21-5/Lactic Acid; 50-99-7/Glucose; 56645-65-9/procalcitonin; 9007-12-9/Calcitonin; 9007-41-4/C-Reactive Protein |
| Comments/Corrections | |
Comment In:
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Crit Care. 2011;15(5):439
[PMID:
21923957
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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