Vol. 5, Issue 2 (2016)

Author(s):
Bari Siddiqui MA, Addanki Yohoshuva

Abstract:
Meningitis accounts for one of commonest neurological diseases in children and adults. To diagnose the pathogen there is need for reliable biochemical tests on CSF. This difficulty can partly be solved by estimation of CSF LDH, CRP and comparing it with their levels in Serum. The present study was undertaken to evaluate the clinical presentation and CSF analysis in pyogenic meningitis with special reference to LDH & CRP estimation. Study was conducted in Department of General Medicine, Neurology and Biochemistry, Government General Hospital Vijayawada and Bhaskar General Hospital, yenkepally. 32 cases of pyogenic meningitis between 18 years to 65 years were taken and 28 cases of individuals undergoing Lumbar puncture for various surgical procedures were taken as controls. Cases below 18 years, aseptic meningitis, traumatic and dry tap on lumbar puncture were excluded from the study. Lumbar puncture was done in all cases where indicated and CSF was collected in sterile bottles and blood was drawn within 1 hour of lumbar puncture. CSF and serum LDH was done by spectrophotometry using Systronics spectrophotometer. CRP was estimated by using Latex Slide Agglutination semi quantitative method (Accurex). Results were analyzed by descriptive statistical analysis. Analysis of variance (ANOVA), CHISQUARE TEST and Z TEST were used. ROC curves, Odds ratio and analysis of logistic regression were done to establish the best diagnostic marker. SSPS 17 and Met cal statistical software was used for statistical analysis. CSF protein was significantly high and CSF/ serum ratio was altered. In majority of cases CSF sugar was less than 2/3 of blood sugar and absent in most of them. LDH was significantly high and CSF/ serum ratio was altered. CRP was positive in almost all cases and was in the range of 0.6 to 9.6 mg/dl and values were corresponding in the serum. CRP and LDH showed a high ODDS ratio and high significance compared to other parameters. CSF CRP is a novel marker with high sensitivity and specificity. LDH and CRP being rapid and cost effective can be used as a supportive evidence of meningitis, along with other routine tests to diagnose pyogenic meningitis.