Serum Procalcitonin level and other biological markers in children with bacterial or non-bacterial meningitis

Acute meningitis in children is predominantly aseptic and does not require specific treatment. However, meningitis has a bacterial origin in about 5% of patients and carries a risk of fatal outcome or severe neurological sequelae, especially when diagnosis and antibiotic administration are delayed. The objective of the present study was to evaluate the value of determining procalcitonin levels to discriminate between bacterial and non-bacterial meningitis in young children or infants and describe the variation in serum PCT levels over time during the treatment of meningitis.A total of 50 children with meningitis admitted to a University Hospital were followed in this prospective study. Cerebrospinal fluid (CSF) and serum levels of procalcitonin were measured. The diagnosis of meningitis was based on clinical findings, gram staining, culture, and chemical analysis of CSF. Twenty-five children were diagnosed as bacterial meningitis and the other 25 children as non-bacterial Meningitis.The mean procalcitonin level on admission in patients with acute bacterial meningitis was 18.3 ng/mL, and the lower level was 4.6 ng/mL, while the higher level in patients with non-bacterial meningitis was 0.62 ng/mL (mean level, 0.38 ng/mL). It  is  clear  from  the  range  of  serum procalcitonin level that, there are no overlapping values seen  for  serum  procalcitonin  in  both  groups.serum PCT levels can be used in the early diagnosis of acute bacterial meningitis and is more valuable than the other predictive marker. Similarly, they may be useful adjuncts in differential diagnosis of bacterial and non-bacterial meningitis and diminishing the value of 2nd lumbar puncture performed 48-72 hours after admission to assess treatment efficacy

A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions