Author(s): Katragadda Suneetha1, H. Vijaya Kumar2
Infectious disease remains a major cause of death and disability for millions around the world, in spite of progress in many antibiotics and preventive strategies. Even though, CNS is protected by blood brain barrier, a system of tight junction around capillaries fail to resist the entry of microorganisms at times. Its presence, prevents the achievement of sufficient concentration of antibiotics in CSF. CNS infections can cause devastating sequelae, and in some cases, it can present as neurological or medical emergencies.
MATERIALS AND METHODS
CSF samples were obtained from 50 patients of clinically suspected cases of meningitis who are admitted in Medicine Department of Government General Hospital, Kakinada, during the period from October 2013 and September 2016. A sample size of 50 patient were included in the study.
CRP levels were elevated in pyogenic meningitis. The mean CRP level in our study was 30.2 ± 5.22 mg/dL. The patients with tuberculous and viral meningitis had a mean CRP level of 2.37 ± 4.79 mg/dL and 1.17 ± 0.31 mg/dL, respectively. In our study, we had high values of ADA in TBM with a mean of 14.17 ± 11.2 U/L. In pyogenic meningitis, it was 3.4 ± 3.03 U/L, and in viral meningitis, it was 1.96 ± 0.99 U/L. Higher cutoff values for ADA helped in separating the overlapped cases of pyogenic and TBM.
As in previous studies, it is apparent from the results of our study that the level of ADA in CSF was considerably elevated in TBM compared with viral meningitis. This conclusion has proved to be extremely beneficial in the treatment of viral meningitis where patients have been started inadvertently on prolonged courses of antitubercular medication with the misdiagnosis of tubercular meningitis. We found that the ADA levels correlated with the severity of clinical presentation. Patients who presented with altered sensorium, cranial nerve involvement and hemiparesis were noted to have higher ADA values. However, there was no clear correlation with the outcome. One fatal case of tubercular meningitis had an ADA of 52 U/L (although, few patients with a mild elevation above the cut-off value have also died).
C-Reactive Protein, Adenosine Deaminase, Meningitis.