Procalcitonin Measurement in Children below 5 Years with Meningitis: Variations and Diagnostic Accuracy

Abstract

Introduction: Differentiating between bacterial and viral meningitis, which is endemic in Senegal, remains difficult due to their clinical similarities. Bacterial culture of cerebrospinal fluid, the gold standard test for diagnosing bacterial meningitis, is time-consuming and lacks sensitivity. Procalcitonin (PCT) is emerging as an important marker specific to bacterial and non-viral infections, offering greater diagnostic accuracy. The overall objective of this study is to evaluate its contribution to the management and triage of children suspected of having meningitis. Materials and Methods: This is a prospective descriptive study conducted at the Children's Hospital of Diamniadio between April 2023 and January 2024. We included patients aged 0 to 5 years with suspected meningitis. The cytochemical examination of CSF was performed using the standard method. PCT and C-Protein Reactive (CRP) measurements were performed using the Architect i 4000 with chemiluminescence and immunoturbidimetry methods, respectively. Results: We collected data from 40 patients under the age group of 5 years. Male subjects accounted for 58% of the total, with a sex ratio of 1.38. The average age was 18.4±15.5 months, with a predominance of patients in the 12-59 month age group (55%). Common symptoms were fever (92.5%), convulsions (65%), and vomiting (40%). Diagnoses mainly included viral meningitis (45%), bacterial meningitis (20%), sepsis (15%) and other types of infections (20%). Mean PCT values were high (13.3 ng/mL) in bacterial meningitis compared to viral meningitis (0.27 ng/mL), with a significant difference (p <0.001). PCT had a sensitivity of 87.5% and a specificity of 88.89% at a threshold value of 0.98 ng/mL. Conclusion: Procalcitonin (PCT) has been shown to be effective in differentiating between bacterial and viral meningitis. It could improve the accuracy of diagnosis and reduce the unnecessary use of antibiotics in cases of viral meningitis. However, it must be used as a complement to clinical examination.