Cerebrospinal fluid C-reactive protein estimation as a rapid bedside diagnostic tool for pyogenic meningitis in children

Background: Pyogenic meningitis is a leading cause of childhood morbidity and mortality in developing countries. Rapid and accurate differentiation of bacterial from non-bacterial central nervous system (CNS) infections remains a significant clinical challenge, particularly in resource-limited settings. C-reactive protein (CRP), an acute-phase reactant, has been proposed as a simple, rapid, and cost-effective bedside test for diagnosing bacterial meningitis.
Methods: A case-control study was conducted in the Department of Paediatrics, Al-Ameen Medical College Hospital, Bijapur, from November 2024 to October 2025. One hundred children (50 culture-positive cases and 50 culture-negative controls) were enrolled. CSF CRP was assessed using the latex agglutination method. CSF culture served as the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.
Results: CSF CRP was positive in 41 of 50 (82%) culture-proven pyogenic meningitis cases and negative in all 50 controls. Sensitivity was 82%, specificity 100%, PPV 100%, and NPV 85%, with an overall diagnostic accuracy of 91%. Klebsiella pneumoniae was the most frequently isolated organism (56%), followed by Escherichia coli (18%) and Pseudomonas aeruginosa (14%). Amikacin (66%) and ciprofloxacin (56%) demonstrated the highest sensitivity profiles.
Conclusions: CSF CRP estimation by latex agglutination is a rapid, reliable, and highly specific bedside test for pyogenic meningitis in children. When combined with standard CSF biochemistry and cell count, diagnostic sensitivity improves to 90%. It is particularly valuable in settings where conventional microbiological facilities are limited.