Usefulness of Cerebrospinal fluid Procalcitonin in Diagnosis of Neonatal Meningitis

Document Type : Original Article

Authors

Department of Pediatrics, SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, India

10.22038/ijn.2025.82969.2601

Abstract

Background: To evaluate the diagnostic utility of Cerebrospinal fluid (CSF) Procalcitonin in the diagnosis of neonatal meningitis.
Study Design: Prospective Observational Study.
Methods: We included 43 neonates with sepsis and suspected meningitis as study subjects. These neonates were categorized into meningitis and non-meningitis groups based on CSF cytology and biochemical parameters.
Results: Among the subjects, 22 neonates were categorized into the meningitis group and 21 neonates were in the non-meningitis group, based on Cerebrospinal fluid cytology and biochemical parameters. The mean CSF Procalcitonin values were 0.48 ± 0.37 ng/ml and 0.20 ± 0.08 ng/ml in the meningitis and non-meningitis groups, respectively. A CSF Procalcitonin cut-off value of 0.13 ng/ml demonstrated a sensitivity of 86.36% and a specificity of 23.81% in diagnosing neonatal meningitis. This cut-off value also yielded a positive predictive value of 54.29% and a negative predictive value of 62.50%, with an area under the curve of 0.789 (0.645-0.933).
Conclusion: CSF Procalcitonin serves as a reliable biomarker. CSF procalcitonin levels can be utilized as an additional diagnostic marker alongside traditional markers such as CSF protein, sugar, cell count, and culture, particularly when CSF culture results are negative, lumbar puncture is traumatic, or the biochemical and cytological analysis of CSF is inconclusive.
 

Keywords


  1. Gordon SM, Srinivasan L, Harris MC. Neonatal meningitis: overcoming challenges in diagnosis, prognosis,and treatment with omics. Front Pediatr 2017; 5:1–10.
  2. Mann K, Jackson MA. Meningitis. Pediatr Rev. 2008;29(12):417–430.
  3. Malbon K, Mohan R, Nicholl R. Should a neonate with possible late ons et infection always have a lumbar puncture? Arch Dis Child. 2006;91(1):
    75–76.
  4. Garges HP, Anthony Moody M, Cotten CM, Smith PB, Tiffany KF, Lenfestey R, et al. Neonatal meningitis: What is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters? Pediatrics. 2006;117(4):1094–1100.
  5. Marcel A, Dominique G, Hervé C, Josette R, Jean G, Claude B. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993; 341:515–518.
  6. Reshi Z, Nazir M, Wani W, Malik M, Iqbal J, Wajid S. Cerebrospinal fluid procalcitonin as a biomarker of bacterial meningitis in neonates. J Perinatol. 2017;37(8):927–931.
  7. Nagaraj M, Bandiya P, Jagannatha B, Shivanna N, Benakappa N, Bandyopadhyay T. Diagnostic utility of cerebrospinal fluid procalcitonin in neonatal meningitis. J Trop Pediatr. 2022;68(3):fmac043.
  8. Rajial T, Batra P, Harit D, Singh NP. Utility of cerebrospinal fluid and serum procalcitonin for the diagnosis of neonatal meningitis. Am J Perinatol. 2020;39(4):373-378.
  9. Shokrollahi MR, Shabanzadeh K, Noorbakhsh S, Tabatabaei A, Movahedi Z, Shamshiri AR. Diagnostic value of CRP, procalcitonin, and ferritin levels in cerebrospinal fluid of children with meningitis. Cent Nerv Syst Agents Med Chem. 2016;18(1):58–62.