Background and Objective: Bacterial meningitis is a serious disease with high rate of
mortality and morbidity in children. Invasion of pathogens causes brain and meningeal inflammation,
which leads to the release of biomarkers into cerebrospinal fluid (CSF). Identification of these biomarkers
can help the physicians to differentiate between bacterial and aseptic meningitis. In the current
study, some of these biomarkers such as Procalcitonin, C reactive protein (CRP), and Ferritin,
were compared in cerebrospinal fluid (CSF) of patients with bacterial and aseptic meningitis.
Methods: In a prospective cross sectional study in a referral children hospital in Tehran during 2011-
2013, the CSF levels of Procalcitonin, Ferritin, and CRP were measured in 57 children with clinically
suspected meningitis. The Mann-Whitney u test and the chi-square test were used to compare two
groups, children with bacterial and aseptic meningitis. The cut-offs of biomarker levels for differentiation
between the 2 groups were constructed by receiver-operating – characteristic curve (ROC).
Results: 57 subjects (30 bacterial and 27 aseptic meningitis), were enrolled in this survey. In comparing
the two groups, the CSF levels of Ferritin, CRP, and procalcitonin in bacterial meningitis were
significantly higher than in aseptic meningitis (P values=˂0.001, 0.001, ˂0.001respectively), with sensitivity/
specificity being 92.9% / 68%, 92.9% / 84%, and 96.4% / 80%, respectively. Positive Predictive
Values (PPV) were, correspondingly, 96.4%, 92.8%, and 92.8% for procalcitonin, Ferritin, and CRP.
Corresponding Negative Predictive Values (NPV) were, respectively equal to 95.4%, 70%, and 88%.
Conclusion: CSF of children with bacterial meningitis contains higher levels of inflammatory mediators
including Procalcitonin, Ferritin, and CRP, compared to aseptic meningitis The biomarkers provided
high sensitivity (especially PCT) and specificity (especially CRP). Using these complementary
biomarkers would be useful for early diagnosis of bacterial meningitis and selection of appropriate