Our experience is that serum C reactive protein gives you little more
information than CBC. Nevertheless, when performing a lumbar puncture
looking for a meningitis the cardinal datum is why you perform it. Itīs
different to perform it to a infant with fever without source or to make it
when you attend a child with low fever, headache, vomiting and meningismus.
These data (and obviously CSF data) let us to make a list of "necessary"
findings that allow to manage this patient at home. These are the following:
older than 1 year, child with symptoms and physical exam compatile with
viral meningitis , CSF data (no bacteria in the Gram stain,
pleocytosis<1000/mm3 with mononuclear predominance or lower
pleocytosis -<100/mm3 with predominance of PMN cells, never more than 90%-
and normal glucorrachia, resting in our Observation Unit for some hours
without incidences, possibility of a correct observation at home, acces to
the hospital and re-exam in the next 24 hours by his pediatrician)
We also have "relative" findings and one of them is the CRP serum value, an
our cutoff point is 30 mg/l.
When we underwent our study we also looked for the value of the C reactive
protein in CSF but the results were disencouraging.
We can't practice (unfortunately) Polymerase chain reaction for enterovirus
in CSF but we think that it's not necessary in all the patients you suspect
enteroviral meningitis. We should reserve it for infants, first cases
attended when epydemia is beginning and you may have more doubts in order to
get a correct diagnosis of these children.
I know that a lot of pediatric emergency pediatricians admitt in the
Hospital all the children with suspected viral meningitis but I'm also sure
that a lot of us are sure that we're attending a child with viral meningitis
before performing lumbar puncture and that out-Hospital management should be
Cruces Hospital. Basque Country. Spain
----- Original Message -----
From: <[log in to unmask]>
To: "sminte" <[log in to unmask]>; <[log in to unmask]>
Sent: Sunday, July 25, 2004 5:07 PM
Subject: Re: viral vs bacterial meningitis
I was curious about your routine practice of performing a CRP in addition to
a CBC in these older children. My understanding is that the CRP is no better
than a CBC in screening for occult SBI. Besides what threshold or cutoff
values for serum CRP are you utilizing? What about the value of a CSF CRP?
Any thoughts would be appreciated.
(from across the pond)
> From: sminte <[log in to unmask]>
> It's very easy for me to talk about a patient when I donīt have to treat
him/her, but I'll tell you what we usually do whith this kind of patients in
my Emergency Department.
> When we attend achild older than 2 years with a clear history of viral
meningitis we pratice CBC, serum CRP, CSF exam and cultures of blood and CSF
(including viral cultures of CSF). If the results are compatible with viral
meningitis (as the results of the child you tell), we send him/her home with
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