Indian Journal of Medical Microbiology Home 

Year : 2001  |  Volume : 19  |  Issue : 3  |  Page : 159--160

Bacteriological study of pyogenic meningitis with special reference to C-reactive protein

SS Tankhiwale, PM Jagtap, RK Khadse, SV Jalgaonkar 
 Department of Microbiology, Indira Gandhi Medical College, Nagpur - 440 018, Maharashtra, India

Correspondence Address:
S V Jalgaonkar
Department of Microbiology, Indira Gandhi Medical College, Nagpur - 440 018, Maharashtra


Seventy five clinically, biochemically and microscopically diagnosed cases of pyogenic meningitis including 28 adults and 47 paediatric patients were studied. Gram positive isolates in adults and gram negative bacilli in paediatric age group were the predominant organisms. Estimation of C-reactive protein (CRP) in cerebrospinal fluid (CSF) and serum was done in all cases as an early marker for rapid diagnosis of pyogenic meningitis. Simultaneous estimation of CRP levels in serum and CSF was found to have a significant diagnostic utility as compared to culture.

How to cite this article:
Tankhiwale S S, Jagtap P M, Khadse R K, Jalgaonkar S V. Bacteriological study of pyogenic meningitis with special reference to C-reactive protein.Indian J Med Microbiol 2001;19:159-160

How to cite this URL:
Tankhiwale S S, Jagtap P M, Khadse R K, Jalgaonkar S V. Bacteriological study of pyogenic meningitis with special reference to C-reactive protein. Indian J Med Microbiol [serial online] 2001 [cited 2020 Aug 14 ];19:159-160
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Full Text

Meningitis continues to be a formidable illness with high morbidity and mortality in India. Gram positive cocci and gram negative bacilli have been incriminated as bacterial aetiological agents of pyogenic meningitis in various studies.[1],[2],[3] C-reactive protein (CRP) is the classic acute phase reactant. CRP levels in serum and cerebrospinal fluid (CSF) have been shown to be increased as a result of invasive central nervous system infection.[4] Isolation of aetiological agent by culture is a time consuming process while estimation of CRP is a rapid diagnostic procedure. The diagnostic utility of serum and CSF-CRP levels is evaluated in the present study.

 Materials and Methods

Clinically, biochemically and microscopically diagnosed seventy five cases of pyogenic meningitis admitted in Indira Gandhi Medical College and General Hospital, Nagpur were investigated. The cases included 28 adult and 47 paediatric patients. Forty age and sex matched controls were also included in the study. Cerebrospinal fluid and 5mL of blood were collected aseptically in sterile containers.Culture of CSF was done for identification of bacterial isolates by conventional methods.[5] Serum and CSF were tested for estimation of CRP by Latex agglutination kit (Tulip Diagnostic (P) Ltd.). CRP levels more than or equal to 18 mg/dL in serum and more than 8mg/dL in CSF were taken as significant.[6] Statistical analysis was done using Chi square test.


In 27 (36%) cases out of 75, bacterial growth was observed in CSF. Streptococcus pneumoniae (21.42%), b haemolytic streptococci (14.29%), Staphylococcus aureus (7.14%) and Micrococci (4%) were isolated in the adult group while Escherichia coli, Streptococcus pneumoniae, nonfermenters (6.38% each), Klebsiella and Pseudomonas species (2.12% each), and Staphylococcus aureus (4.25%) were isolated in the paediatric age group. Thus gram positive cocci in the adult group and gram negative bacilli in the paediatric group were the predominant organisms. Similar findings have been reported in other studies.[1],[2],[3] Sensitive assays like Latex agglutination are available for detection of CRP and increasingly used for biological application. There is no uniform agreement about the sensitivity of CSF-CRP levels in predicting pyogenic meningitis. High sensitivity rates were found in some studies.[7],[8] Whereas low levels were reported in neonates using laser nephalometry technique.[9],[10] In our study 32 out of 75 cases (42.66%) were positive for CSF-CRP. This included all the 27 culture positive cases. Thus five non-culture positive cases also showed high CRP levels in CSF though the difference is not statistically significant [table].

Sixty six patients out of 75 (88%) showed high levels of CRP in serum. Similar findings were reported by other workers.[4],[11],[12] Out of these, 32 were positive for CSF-CRP. While 34 were positive for only serum CRP. Thus total of 66 patients showed raised CRP levels either in serum or CSF while only 27 yielded bacterial growth in culture. The difference is statistically significant [Table].

From the present study it appears that CRP estimation when done in serum and CSF simultaneously, can help in diagnosing cases of pyogenic meningitis more effectively than culture. Moreover Latex agglutination test is a cost effective and rapid test compared to culture which can be useful in early institution of therapy and ensure better prognosis.


Authors are grateful to Dr. SK Kate, Dr. SD Suryavanshi, Department of Medicine and Dr. VS Dani, Department of Paediatrics, for clinical evaluation of cases and Miss Nalini Reddy for technical assistance. Thanks are due to Dr. WB Tayade, Dean, for permitting to carry out and publish the work.


1Smith ES. Purulent meningitis in infants: A review of 409 cases. J Paed 1954; 45: 425-428.
2Swartz MN, Dodge PR. Bacterial meningitis: A review of selected aspects, general clinical features, special problems and unusual reactions mimicking bacterial meningitis. New England J Med 1965; 275: 725-731.
3Coornard JD, Rytel MW. Determination of etiology of bacterial meningitis by counterimmunoelectrophoresis. Lancet 1972; I: 1154-1157.
4Peltora HO. CRP for rapid monitoring of infections of central nervous system. Lancet 1982; 1: 980-983.
5Collee JG, Marmion BP, Frazer AG, Simmiens A. Mackie and McCartney's text book of Practical Medical Microbiology: 14th ed. (Churchill Livingston produced by Longman Singapore Publisher Pvt. Ltd.) 1997, Vol. II 628-633.
6De Beer FC, Kirsten GF, Gie RP, Beyers N, Strachan AF. Value of CRP measurement in tuberculosis, bacterial and viral meningitis. Arch of Dis in childhood 1984; 59: 653-656.
7Corrall JC, Pepple JM, Moxon ER, Huges WT. CRP in CSF of children with meningitis J paediatr 1981; 99: 365-369.
8Abramson JS, Hampton KD, Babu S, Wasilaukas BL, Maron MJ. The use of CRP from CSF for differentiating meningitis from other CNS disorders. J Infect Dis 1985; 151: 854-858.
9Philips AGS, Baker CJ. CSF CRP in neonatal meningitis. J Paediatr 1983; 102:715-717.
10Benzamin DR, Olpheim KE, Brewal. Is CRP useful in the management of children with suspected bacterial meningitis? Am J Clin Path 1984; 81: 779-792.
11Singh UK. CSF CRP in the diagnosis of meningitis in children. Indian Paediatr 1994; 31: 939-942.
12Pemde HR. CRP in childhood meningitis. Indian Paediatr 1996; 63: 73-77.