Role of C- reactive proteins in cerebro-spinal fluid in differentiating pyogenic from nonpyogenic meningitis


  • Sharad Jain Department of Pathology, NSCB Medical College Jabalpur, Madhya Pradesh
  • Rashmi Nayak Department of Pathology, NSCB Medical College Jabalpur, Madhya Pradesh
  • Anand Sharma Department of Pathology, NSCB Medical College Jabalpur, Madhya Pradesh



C-reactive protein, Pyogenic meningitis, tubercular meningitis, viral meningitis, CSF, meningitis


Background:In developing countries like India meningitis is major cause of morbidity and mortility because of delay in proper diagnosis and consequently delay in proper treatment.  For the appropriate treatment of meningitis, differentiation of various types of meningitis is essential. The diagnosis of meningitis in a govt. hospitals is usually made by examination of CSF, Gram staining, AFB, CSF culture and associated clinical findings. All these laboratory techniques have their limitations. So we need a diagnostic test which is rapid, reliable and cost effective. In the present study we used CRP levels in CSF sample to differentiate pyogenic from non-pyogenic meningitis and to establish a cut off level for CRP.

Methods: The study is a hospital based prospective study carried out in the setting of department of pathology, microbiology, casuality and various wards of Netaji Subash Chandra Bose Medical College Jabalpur (M.P) India during November 2014 to October 2015. During study period we took samples (Blood and CSF) from 138 cases of suspected meningitis.

Results: Value of CRP was 32.50645±2.032886 in PM cases, 1.543373±0.195181 in TBM cases and VM cases value were 2.420833±0.357502. Statistically significantly higher value was observed with pyogenic meningitis cases compared to TBM and VM cases. (p<0.001).  At 10 U/L cut off value, sensitivity and specificity of CSF- CRP was 93.5% and 94.4% respectively.

Conclusions: On the basis of present study we concluded that CRP can be used as a rapid confirmatory test since elevated CRP are highly suggestive of pyogenic meningitis.



Verma A, Solbrig MV, Neurology in clinical practice. 4ed. Joseph Jankovic; Elsevier. 2004;1473.

Smith E. C-reactive protein in the emergency department. Emer Med J 2006;23:2413

Goran R, Finzi-Yeheskel Z, Rajs A, Mayer M. C-reactive protein concentrations in cerebrospinal fluid in gram-positive and gram-negative bacterial meningitis. ClinChem. 2002;48:591-2.

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

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 nontubercular meningitis. 1992;36(3):317-25

Ribeiro MA, Kimura RT, Irulegui. Cerebrospinal fluid levels of lysozyme, IgM and C-reactive protein in the identification of bacterial meningitis. J Trop Med Hyg.1992;95(2):87-94.

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

Prasad R, Kumar A, Khanna BK, Mukherji PK, Agarwal SK, Kumar A, Shrivastava VML. Adenosine deaminase in cerebrospinal fluid for diagnosis of tubercular men ingitis. Ind J Tub. 1991;38:99-10.

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.

Shiemetani N, Shimetani K, Mori M. Levels of three inflammation markers, C-reactive protein, serum amyloid a protein and procalcitonin 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 protein and its significance in purulent meningitis. Neuro Neurochir Pol. 1996;30(1):17.

Gerdes LU, Jorgensen PE, Nexo E, Wang P. C-reactive protein and bacterial meningitis: A meta- analysis. Scand J Clin Lab Invest. 1998;58(5):383-93.

Sutinen J, Sombrero L, Paladin FJ. Etiology of central nervous system infections in the Philippines and the role of serum C-reactive protein in excluding acute bacterial meningitis. Int J Infect Dis. 1998;3(2):88-93.

Tankhiwale SS, Jagtap PM, Khadse RK, Jaigaonkar SV. Bacteriological study of pyogenic meningitis with special reference to C-reactive protein. Ind J Med Microbiol. 2001;19(3):255-61.

Kerner A, Avizohar O, Sella R. Association between elevated liver enzymes and C-reactive protein. Aeteriosclerosis, thrombosis and vascular Biology. 2005;25:193.

Rooijen VM, Hansson LO, Frostegard J, Silveira A, Hamsten, Bremme K. Treatment with combined oral contraceptives includes a rise in serum C-reactive protein in the absence of a general inflammatory response. J Thromb Haemost. 2006;4(1):77-82.




How to Cite

Jain, S., Nayak, R., & Sharma, A. (2017). Role of C- reactive proteins in cerebro-spinal fluid in differentiating pyogenic from nonpyogenic meningitis. International Journal of Research in Medical Sciences, 4(7), 2839–2842.



Original Research Articles