Abstract
BACKGROUND: Bacterial meningitis (BM) is a potentially life-threatening condition that could rapidly progress to permanent brain damage, neurologic complications, or even death. Diagnostic tools to distinguish between BM and aseptic meningitis (AM) are essential to target the appropriate treatment to patients at great risk and concurrently spare patients with AM from wrongful prescription. The aim was to evaluate the diagnostic utility of cerebrospinal fluid (CSF)-malondialdehyde (MDA), C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels for differentiating BM and AM in all age groups. METHODS: This was a 2-year retrospective study involving suspected meningitis cases from the five regions of Northern Ghana. We employed a Real-Time PCR multiplex assay to directly detect Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae, simultaneously from CSF samples. Analysis of CRP, LDH, and MDA, respectively, was run on the Mindray BS240 automated chemistry analyzer (Mindray Inc., Nanshan, Shenzhen, China) and by the TBARS ASSAY (Solarbio Inc., China). RESULTS: Only 90 S. pneumoniae were detected in the 210 CSF samples screened. Though a greater proportion of patients with BM and AM had elevated levels of MDA and CRP, a significant difference (p < 0.001) was only established between CRP levels of BM and AM cases. Measured LDH levels were rather low in the majority of both BM and AM cases. Patients' clinical outcomes for the biomarkers revealed; MDA levels of patients who died had no significant difference in odds (OR = 1.169, 95% CI: 0.114-12.372, p > 0.05) compared to those alive; but the CRP levels of dead patients had a higher odds (OR = 13.058, 95% CI: 2.864-59.526, p < 0.05) of having high abnormal CRP compared to those alive. The LDH levels of dead patients had a decreased risk (OR = 0.121 with a 95% CI: 0.020, 0.812, p > 0.05) of experiencing low abnormal levels of LDH compared to patients alive. CONCLUSION: The MDA and LDH levels were not reliable for distinguishing BM status in this study population; rather, CRP was a stronger biomarker for differentiating BM from AM. Larger prospective studies are required to investigate the role of these biomarkers in BM cases.