Role of serum procalcitonin in monitoring the response to treatment of pediatric meningitis

Role of serum procalcitonin in monitoring the response to treatment of pediatric meningitis Ahmad M.1, Iqbal J.2, Ahmad Wani F.3, Wajid Ali S.4 DOI: https://doi.org/10.17511/ijpr.2020.i07.06 1 Mudasir Ahmad, DNB Scholar, Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, , India. 2 Javeed Iqbal, Associate Professor, Department of Neonatology and Pediatrics, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India. 3 Feroz Ahmad Wani, Lecturer, Department of Community Medicine, Govt. Medical College, Srinagar, Jammu and Kashmir, India. 4 Syed Wajid Ali, Ex-Professor, Department of Neonatology and Pediatrics, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India.


Introduction
Meningitis is a severe acute infectious disease caused by several microorganisms, including viruses, bacteria, parasites, and fungi. Fatality rates associated with this disease can be as low as 2% in infants and children, and as high as 20 A good biomarker for meningitis should provide early diagnosis, be a good prognostic marker, and be helpful for therapeutic antimicrobial decisions.
Because the consequences of delayed diagnosis of bacterial meningitis can be severe, any proposed diagnostic tool must achieve near 100% sensitivity Among new markers, serum procalcitonin (PCT) level seems to be one of the most sensitive and specific predictors for discriminating between bacterial and non-bacterial infections [10] because PCT expression is only slightly induced, if at all, by viral infections, autoimmune diseases, neoplastic diseases and trauma of surgical intervention [11].
Only a few published studies have focused on the value of serum PCT for therapeutic decisions in meningitis and present conflicting results. Hence a current study was designed to see the role of serum procalcitonin as a therapeutic marker in bacterial meningitis in the pediatric age group i.e. to see the role of serum procalcitonin in determining the response to treatment.

Material and methods
This study was conducted among suspected cases of bacterial meningitis who were admitted to the Department of Neonatology and Pediatrics in SKIMS, Srinagar.

Duration and type of study:
The prospective type of study was conducted over 1 year.
Sampling methods: All the suspected cases of pediatric meningitis were enrolled for the study. Values were expressed as mean ± SD and p-value < 0.05 was considered significant.      and 1.52±3.03 ng/ml, respectively and was also consistent with the study conducted by Ibrahim KA et al [13] in which follow up of the studied cases, showed a significant decrease in procalcitonin levels on day 3 and day 6 after antibiotic treatment.
This result is again consistent with that obtained by many authors, [15][16][17] who found that serum procalcitonin decreased to a very low, and may to an unidentifiable level with treatment, making it a valuable parameter for evaluating the efficacy of antibiotic treatment and hence diminishing the need for lumbar puncture performed 48-72 hours after admission to assess treatment efficacy. Gendrel D et al (1997) observed that all the patients followed for PCT levels had < 1 mg/L of PCT at recovery [18].
Further, it was observed by Schwarz S et al (2000) that persistently elevated or increasing PCT levels after 2 days of admission were associated with unfavorable clinical outcomes [19].
These findings are in agreement with Monneret G et al (1997) study where they found that high levels of PCT correlated with bacterial invasion and PCT returned to normal range (< 0.1 micrograms) more quickly than C-reactive protein, suggesting that PCT may be an early marker of favorable outcome [20].

Limitations
The study was dependent on the number of pediatric meningitis cases admitted to the hospital.
Only 45 participants during the one year full filled the inclusion criteria.

Conclusion
Therefore, it was concluded that serum procalcitonin besides being a diagnostic marker for meningitis is also a good follow-up tool to see the response to treatment.