Main Article Content
Abstract
Infection of the central nervous system in pediatric patients have a high mortality as well as acute and chronic neurological sequelae. Signs of the disease are unclear, so cerebrospinal fluid (CSF) test is used as a gold standard for diagnosis, but the investigation has faced many obtacles. Empiric antibiotic therapy is the key factor in reducing morbidity and mortality. Microbiological culture result is obtained within 5-7 days. The effectiveness of empirical antibiotic use is questionable. Therefore, other investigations are conducted to determine the effectiveness of antibiotics by using one marker, the CRP. This study was to analyze CRP level in supporting antibiotic therapy effectiveness in pediatric patients with central nervous system (CNS) infections. A prospective cohort study was conducted to determine the relationship of CRP with other parameters, including clinical, microbiological and laboratory, in pediatric patients with central nervous system infections. Patients meeting blood samples criteria were taken before (H0), the third day (H3) and the fifth day (H5) after antibiotics administration. This study involved 10 patients with central nervous system infections (meningoencephalitis, encephalitis and encephalitis with cerebral edema). Six patients were male, with ages less than a year. Antibiotic treatment effectiveness was associated with improved condition of the patients' CRP level. It was 3.558 ±3.196 before (H0), 3.878±2.813 on the third day (H3) and 3.891±2.204 on the fifth day (H5) after antibiotic administration. Leukocyte levels were 13.680±1.660 before (H0), 17.832±7.213 on the third day (H5), and 10.546±3.671 on the fifth day (H5) after antibiotic administration. Pearson's correlation test analysis performed on CRP and WBC parameters showed H0 p=0.981, CRP and WBC H3 p=0.621, while CRP and WBC H5 obtained significance p=0.644. There was no significant correlation observed between CRP and WBC parameters before and after antibiotic administration. In conclusion, there was no correlation of CRP levels with clinical, laboratory and micobiological parameters in patients with central nervous system infections.
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Copyright (c) 2016 Melawati Olevianingrum, Yulistiani Yulistiani, Darto Saharso, Nun Zairina
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References
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- Chavez-Bueno, S and McCracken, G. H (2005). Bakterial meningitis in children. Pediatric Clinics of North America 52: 795-810.
- Clyne B, Olshaker JS. 1999. The C-reactive protein. J Emerg Med;17:1019.
- David Somand, MDa,WilliamMeurer, 2009. Central Nervous System InfectionsMD. Emerg Med Clin N Am. 27;89–100
- Fisher RG, Boyce TG. 2005. Purulent meningitis. Dalam: Fisher RG, Boyce TG. Penyunting Moffet's pediatric infectious diseases: a problem-oriented approach. Ed 4th Philadelphia; Lippincont Williams & Wilkins, pp. 243-264
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- JustineMiranda, MDa, Allan R.Tunkel, MD. 2009. Strategies and New Developments in the Management of Bacterial Meningitis. Infect Dis Clin N Am. 23;925–943
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- Kwang Sik Kim.2010. Acute bacterial meningitis in infants and children. Division of Pediatric Infectious Diseases. Lancet Infect Dis ; 10: 32–42.
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- Lampiris, H.W. and D.S. Maddix, 2012, Clinical Use of Antimicrobial Agents, In:Katzung, B.G, S.B. Masters, and A.J.Trevor, Basic and Clinical Pharmacology 12th Ed., Mc.Graw Hill Companies, Inc, p. 901-913.
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- McDade T.W. Leonard, W.R et al.2005. Predictors of C-Reactive Protein in Tsimane. 2 to 15 Year-Olds in Lowland Bolivia. American Journal Of Physical Anthropology 128:906–913
- Michael Scheld, W. Uwe Koedel, Barnett Nathan, and Hans-Walter Pfister.2002. Pathophysiology of Bacterial Meningitis: Mechanism(s) of Neuronal Injury. The Journal of Infectious Diseases ;186(Suppl 2):S225–33.
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- Ogunlesi TA. 2013. Diagnosis and treatment of bacterial meningitis in the newborn. Niger J Paed; 40 (1): 6 –14
- Pagana, K.D., and Pagana, T,J., 2002, Mosby's Manual of Diagnostic and Laboratory Test 2nd ed., St. Louis:Mosby, Inc, pp. 77 – 85.
- Pedro Póvoa et al. 2002., C-reactive protein: a valuable marker of sepsis. Intensive Care Med 28:235–243
- Pepys MB, Hirschfield GM. 2003., C-reactive protein: a critical update. J Clin Invest ;111:1805-12.
- Philip O. Anderson, James E. Knoben,, William G. Troutman. 2002. Clinical drug data, tenth edition 2002The McGraw-Hill Companies
- Prober CG. 2009. Acute Bacterial Meningitis. Nelson textbook of pediatric. Ed 18th. pp 2513-2522.
- Pourcyrous.M, Henrietta S. Bada, Sheldon B. Korones, Vickie Baselski and Seok P.wong.1993. Significance of Serial C-Reactive Protein Responses in Neonatal Infection and Other disorder. Pediatrics ;92;431
- Prasad Col PL., Brig MNG Nair., Lt Col AT Kalghatgi., 2004. Childhood Bacterial Meningitis and Usefulness of C-reactive Protein. MJAFI, Vol. 61.
- RazonablesR.R.2005. Meningitis. Division of Infectious Diseases Department of Medicine. Mayo Clinic College of Medicine.www.emedicine.com/med/topic2613.htm
- Roland Nau, Fritz Sörgel and Hilmar W. Prange. 1998. Pharmacokinetic Optimisation of the Treatment of Bacterial Central Nervous System Infections. Clin Pharmacokinet., 35 (3): 223-246
- Rosman NP. 2003. Evaluation of the child who convulses with fever. Pediatr Drugs. p: 5:457-61
- Richard F. Mortensen and Wangjian Zhong. 2000. Regulation of phagocytic leukocyte activities by C-reactive protein. Department of Microbiology, The Ohio State University, Columbus.
- Roord J.John, Marceline Van Furth.A and Ralph Van Furth. 1996. Roles of Proinflammatory and Anti-Inflammatory Cytokines in Pathophysiology of Bacterial Meningitis and Effect of Adjunctive Therapy. p. 4883–4890 Vol. 64, No. 12
- Saez-Llorens, X and McCracken Jr, G. H. 2003. Bakterial meningitis in children. Lancet., 361: 2139-2148.
- S. Ehl, B. Gering, P. Bartmann, J. H¨ogel, and F. Pohlandt. 1997. C-reactive protein is a useful marker for guiding duration of antibiotic therapy in suspected neonatal bacterial infection. Pediatrics, vol. 99, no. 2, pp. 216–221.
- Sharon E. Mace,et al.2008. Acute Bacterial Meningitis. Emerg Med Clin N Am. 38 281–317
- Stevens JP, Eames M, Kent A, Halket S, Holt D, Harvey D. 2003. Long term outcome of neonatal meningitis. Arch Dis Child Fetal Neonatal Ed;88:F179-F184.
- Taskin, E., Turgut, M., Kilic, M., et al. 2004. Serum procalcitonin and cerebrospinal fluid cytokines level in children with meningitis mediators of Inflammation. 13(4): 269-273.
- Teresa C. Horan, MPH, Mary Andrus, RN, BA, CIC, and Margaret A. Dudeck. 2013. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. MPH Atlanta, Georgia
- Terry W. Du Clos and Carolyn Mold.2003. C-Reactive Protein: Structure, Synthesis and Function. Immunobiology of Carbohydrates
- Trissel, L.A, 2009, Handbook on Injectable Drugs, 15th Ed. USA:American Society of Health-System Pharmacist, Inc.
- Tunkel, A. R., B. J. Hartman, et al. 2004. Practice guidelines for the management of bakterial meningitis. Clin Infect Dis 39(9): 1267-1284.
- Urowayino, O. E., Afolabi, L. F., Chinyere, E. K., and Olufunmilayo, G. A. 2004. Neurological sequelae in children with pyogenic meningitis in a tertiary centre in Lagos (Nigeria). African J Neurol Sci 23: 31-38.
- Ziai, W. C. and J. J. Lewin. 2008. Update in the Diagnosis and Management of Central Nervous System Infections. Neurologic Clinics 26(2): 427-468.
References
Alam, A. 2011. Kejadian meningitis bakterial pada anak usia 6-18 bulan yang menderita kejang demam pertama. Sari Pediatri 13(4): 293-298.
American College of Surgeon Committe on Trauma. 2004. Cedera kepala. Dalam: Advanced Trauma Life Support for Doctors. Ikatan Ahli Bedah Indonesia, penerjemah. Edisi 7. Komisi trauma IKABI; 168-193.
Amsden, G.W., C.H. Ballow, J.S. Bertino, JR., and A.D.M. Kashuba, 2010, Pharmacokinetics and Pharmacodynamics of Anti-infective Agents, In:Mandell,
Archer, G.L. and R.E. Polk, 2010, Treatment And Prophylaxis of Bacterial Infections, In:Kasper, D.L and A.S. Fauci, Harrison's Infectious Diseases, USA:The MacGraw-Hill Companies, p. 354-375.
Barry B. Mook-Kanamori, Madelijn Geldhoff, Tom van der Poll and Diederik van de Beek.2011. Pathogenesis and Pathophysiology of Pneumococcal Meningitis. Clin. Microbiol, 24(3):557.
Chavez-Bueno, S and McCracken, G. H (2005). Bakterial meningitis in children. Pediatric Clinics of North America 52: 795-810.
Clyne B, Olshaker JS. 1999. The C-reactive protein. J Emerg Med;17:1019.
David Somand, MDa,WilliamMeurer, 2009. Central Nervous System InfectionsMD. Emerg Med Clin N Am. 27;89–100
Fisher RG, Boyce TG. 2005. Purulent meningitis. Dalam: Fisher RG, Boyce TG. Penyunting Moffet's pediatric infectious diseases: a problem-oriented approach. Ed 4th Philadelphia; Lippincont Williams & Wilkins, pp. 243-264
Gessner, B. D., Sutanto, A., Linehan, M., et al. 2005. Incidences of vaccine-preventable Haemophilus influenza type B pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial. Lancet 365: 43-52.
JustineMiranda, MDa, Allan R.Tunkel, MD. 2009. Strategies and New Developments in the Management of Bacterial Meningitis. Infect Dis Clin N Am. 23;925–943
Kasper, Fauci et al. 2009. Harrison's Infectious Disease., Mc. Graw Hill Companies
Katherine B. Bodman-Smith, Rachel E. Gregory et al, 2004. Fc_RIIa expression with Fc_RI results in C-reactive protein and IgG-mediated phagocytosis, Department of Infectious and Tropical Diseases
Kaushal.R.K, Jaswal.R.S, Goel.A, and Pathania.K. 2003. Role of C-reactive protein in deciding duration of antibiotic therapy in neonatal septicemi. Indian Pediatrics, vol. 40, no. 9, pp. 880–883.
Kumar, A. 2005. Bacterial meningitis. Department of Pediatrics and Human Development Michigan State University. College of Medicine and En Sparrow Hospital. www.emedicine.com/PED/topic198.htm.
Kwang Sik Kim.2010. Acute bacterial meningitis in infants and children. Division of Pediatric Infectious Diseases. Lancet Infect Dis ; 10: 32–42.
Lacy C.F., Armstrong, L.L., Goldman M.P., Lance L.L., 2010, Drug Information Handbook, 18th Ed., American Pharmacist Association, USA:Lexi Comp, Inc.
Lampiris, H.W. and D.S. Maddix, 2012, Clinical Use of Antimicrobial Agents, In:Katzung, B.G, S.B. Masters, and A.J.Trevor, Basic and Clinical Pharmacology 12th Ed., Mc.Graw Hill Companies, Inc, p. 901-913.
Laurence L. Brunton, John S Lazo, Keith L. Parker. 2006. Goodman & Gilman's the Pharmacological Basis of Therapeutics. 11th Ed McGraw-Hill Companies.
Mandell Lionel A and Richard Wunderink, 2010, Principle and practice of infectious diseases., 7th. Churchill livingstone: Elsevier
M.Evoy, G.K., 2011, AHFS Drug Information, American Society of Health System Pharmacist, USA.
McDade T.W. Leonard, W.R et al.2005. Predictors of C-Reactive Protein in Tsimane. 2 to 15 Year-Olds in Lowland Bolivia. American Journal Of Physical Anthropology 128:906–913
Michael Scheld, W. Uwe Koedel, Barnett Nathan, and Hans-Walter Pfister.2002. Pathophysiology of Bacterial Meningitis: Mechanism(s) of Neuronal Injury. The Journal of Infectious Diseases ;186(Suppl 2):S225–33.
Mills.P.C and Philip. A.G. 2000. Use of C-reactive protein in minimizing antibiotic exposure: experience with infants initially admitted to a well-baby nursery. Pediatrics, vol. 106, no. 1, p. E4
Nicola Principi, Susanna Esposito. 2012. Diagnosis and therapy of tuberculous meningitis in children. Department of Maternal and Pediatric Sciences, Universití degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9 Milan, Italyen
Olaf Hoffman and Joerg R. Weber.2009., Pathophysiology and treatment of bacterial meningitis. Ther Adv Neurol Disord 2(6) 401_412
Ogunlesi TA. 2013. Diagnosis and treatment of bacterial meningitis in the newborn. Niger J Paed; 40 (1): 6 –14
Pagana, K.D., and Pagana, T,J., 2002, Mosby's Manual of Diagnostic and Laboratory Test 2nd ed., St. Louis:Mosby, Inc, pp. 77 – 85.
Pedro Póvoa et al. 2002., C-reactive protein: a valuable marker of sepsis. Intensive Care Med 28:235–243
Pepys MB, Hirschfield GM. 2003., C-reactive protein: a critical update. J Clin Invest ;111:1805-12.
Philip O. Anderson, James E. Knoben,, William G. Troutman. 2002. Clinical drug data, tenth edition 2002The McGraw-Hill Companies
Prober CG. 2009. Acute Bacterial Meningitis. Nelson textbook of pediatric. Ed 18th. pp 2513-2522.
Pourcyrous.M, Henrietta S. Bada, Sheldon B. Korones, Vickie Baselski and Seok P.wong.1993. Significance of Serial C-Reactive Protein Responses in Neonatal Infection and Other disorder. Pediatrics ;92;431
Prasad Col PL., Brig MNG Nair., Lt Col AT Kalghatgi., 2004. Childhood Bacterial Meningitis and Usefulness of C-reactive Protein. MJAFI, Vol. 61.
RazonablesR.R.2005. Meningitis. Division of Infectious Diseases Department of Medicine. Mayo Clinic College of Medicine.www.emedicine.com/med/topic2613.htm
Roland Nau, Fritz Sörgel and Hilmar W. Prange. 1998. Pharmacokinetic Optimisation of the Treatment of Bacterial Central Nervous System Infections. Clin Pharmacokinet., 35 (3): 223-246
Rosman NP. 2003. Evaluation of the child who convulses with fever. Pediatr Drugs. p: 5:457-61
Richard F. Mortensen and Wangjian Zhong. 2000. Regulation of phagocytic leukocyte activities by C-reactive protein. Department of Microbiology, The Ohio State University, Columbus.
Roord J.John, Marceline Van Furth.A and Ralph Van Furth. 1996. Roles of Proinflammatory and Anti-Inflammatory Cytokines in Pathophysiology of Bacterial Meningitis and Effect of Adjunctive Therapy. p. 4883–4890 Vol. 64, No. 12
Saez-Llorens, X and McCracken Jr, G. H. 2003. Bakterial meningitis in children. Lancet., 361: 2139-2148.
S. Ehl, B. Gering, P. Bartmann, J. H¨ogel, and F. Pohlandt. 1997. C-reactive protein is a useful marker for guiding duration of antibiotic therapy in suspected neonatal bacterial infection. Pediatrics, vol. 99, no. 2, pp. 216–221.
Sharon E. Mace,et al.2008. Acute Bacterial Meningitis. Emerg Med Clin N Am. 38 281–317
Stevens JP, Eames M, Kent A, Halket S, Holt D, Harvey D. 2003. Long term outcome of neonatal meningitis. Arch Dis Child Fetal Neonatal Ed;88:F179-F184.
Taskin, E., Turgut, M., Kilic, M., et al. 2004. Serum procalcitonin and cerebrospinal fluid cytokines level in children with meningitis mediators of Inflammation. 13(4): 269-273.
Teresa C. Horan, MPH, Mary Andrus, RN, BA, CIC, and Margaret A. Dudeck. 2013. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. MPH Atlanta, Georgia
Terry W. Du Clos and Carolyn Mold.2003. C-Reactive Protein: Structure, Synthesis and Function. Immunobiology of Carbohydrates
Trissel, L.A, 2009, Handbook on Injectable Drugs, 15th Ed. USA:American Society of Health-System Pharmacist, Inc.
Tunkel, A. R., B. J. Hartman, et al. 2004. Practice guidelines for the management of bakterial meningitis. Clin Infect Dis 39(9): 1267-1284.
Urowayino, O. E., Afolabi, L. F., Chinyere, E. K., and Olufunmilayo, G. A. 2004. Neurological sequelae in children with pyogenic meningitis in a tertiary centre in Lagos (Nigeria). African J Neurol Sci 23: 31-38.
Ziai, W. C. and J. J. Lewin. 2008. Update in the Diagnosis and Management of Central Nervous System Infections. Neurologic Clinics 26(2): 427-468.