The Use of C-Reactive Protein from Cerebrospinal Fluid for Differentiating Meningitis from Other Central Nervous System Diseases

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Abstract
C-reactive protein (C-RP) determinations were performed by using the latex slide agglutination test on cerebrospinal fluid (CSF) from 235 patients. The patients were categorized into the following groups: (1) bacterial meningitis (n = 74); (2) viral meningitis (n = 10); (3) fever without bacterial meningitis (n = 80); (4) neurological symptoms without infection (n = 25); (5) intracranial hemorrhage (n = 10); (6) increased intracranial pressure that was secondary to pseudotumor cerebri or hydrocephalus (n = 16); and (7) malignancies (n = 20). On the initial lumbar puncture, the C-RP was positive in 97% (72 of 74) of the patients in group 1, as compared with 0% (0 of to), 6% (5 of 80), 20% (5 of 25), 50% (5 of to), 6% (l of 16), and 30% (6 of 20) in groups 2–7, respectively (P < .0001). The C-RP test was able to detect bacterial meningitis with a sensitivity of 97% (72 of 74), a specificity of 86% (139 of 161), a positive predictive value of 77% (72 of 94), and a negative predictive value of 99% (139 of 141).These data indicate that C-RP determinations performed on CSF are useful and rapid clinical tests for the exclusion of the presence of bacterial meningitis in a patient.

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