Rapid differential diagnostic methods of meningitis in adults

Akkamahadevi V. Nipanal, Nagappa H.


Background: Acute infections of the nervous system are among the most importantproblems in medicine because early recognition, efficient decision making, and rapid institution of therapy can be lifesaving. Objective of the present study was to find out the usefulness of these two tests, CSF-ADA and CSF-CRP for the rapid diagnosis and differentiation of bacterial, tubercular and viral meningitis in adults.

Methods: Fifty meningitis patients were selected after fulfilling the following inclusion and exclusion criteria. A prospective clinical evaluation study is undertaken to study the predictive value of CSF CRP and ADA in relation to various types of meningitis.

Results: More than half the cases reported were of tubercular meningitis, followed by viral and pyogenic meningitis. The percentages of tubercular, viral and pyogenic were 52%, 32% and 16% respectively. CRP levels were elevated in pyogenic meningitis; the mean CRP level was 25.26±5.56 mg/dl. ADA activity was found to highest in tubercular meningitis, the mean value was 17.67±8.13 IU/L.

Conclusions: Study concluded that combine use of CSF CRP and ADA can be used for early differentiation of bacterial, tubercular, and viral meningitis.


ADA (adenosine deaminase), CSF (cerebrospinal fluid), CRP (C reactive protein), ICP (Intracranial pressure)

Full Text:



Roos RL, Tyler KL. Harrison’s Principles of Internal Medicine.19th edition. New York: McGraw Hill. 2015:883-906.

Verma A, Solbrig MV. Neurology in Clinical Practice. 4th edition. Joseph Jankovic; Elsevier. 2004:1473.

Johnson AM. Teitz textbook of clinical chemistry and molecular diagnostics.4th edition. Butterworth Heinemann. 1999:555-556.

Surana NK, Kasper DL. Harrison’s Principles of Internal Medicine.19th edition. New York: McGraw Hill. 2015:761-768.

Stearman M, Southgate HJ. The use of cytokine and C-reactive protein measurements in cerebrospinal fluid during acute infective meningitis. Ann Biol Clin. 1994;31:255-61.

Shimetani N, Shimetani K, Mori M. Levels of three inflammation markers, C- reactive protein, serum amyloid A protein and procalciton in in the serum and cerebrospinal fluid of patients with meningitis. Scand J Clin Lab Invest. 2001;61(7):567-74.

Hemavani N, Chitnis D, Joshi SP. C-reactive protein in CSF and its role in differential diagnosis of meningitis. Ind J Med Microb. 2001;19(1):26-9.

Przyjalkowski W, Lipowski D, Kolasa T, Issa E, Janeczko J. C-reactive proteinand its significance in purulent meningitis. Neuro Neurochir Pol. 1996;30(1):177.

Rajamani S. Estimation of C-reactive protein in serum and CSF for diagnosis of various meningitis. JAPI. 2003;51:1279.

Vaishnavi C, Dhand UK, Dhand R, Agnihotri N, Ganguly NK. C-reactive proteins, immunoglobulin profile and mycobacterial antigens in cerebrospinal fluid of patients with pyogenic and non tuberculous meningitis. 1992;36(3):317-25.

Rajs G, Yeheskel Z, Rajs A, Mayer M. C-Reactive protein concentration in cerebral spinal fluid in gram-positive and gram-negative bacterial meningitis. Clin Chem. 2002;48:591-2.

Ray P, Acossi G, Viallon A, Boutoille D. Accuracy of cerebrospinalfluid results to differentiate bacterial from non-bacterial meningitis, in case of negative gram stained smear. Am J Emerg Med. 2007;25(2):179-84.

Gambhir IS, Mehta M, Singh DS, Khanna HD. Evaluation of CSF-Adenosine deaminase activity in tubercular meningitis. JAPI. 1999;47(1):192-4.

Choi SH, Kim YS, Bae IG, Chung JW, Lee MS, Kang JM et al. The possible role of cerebrospinal fluid adenosine deaminase activity in the diagnosis of tuberculous meningitis in adults. Clin Neurol Neurosurg. 2002;104:10-5.