Sensitivity and Specificity CSF Heat Shock Protein Levels in Differentiation of Bacterial Meningitis: A Cross Sectional Study: Tehran, Iran

Background: Bacterial meningitis is a fatal disease with high mortality and morbidity that needs emergency management.

Objective: Determination the sensitivity and specificity CSF Heat Shock Protein 70 levels in differentiation of bacterial meningitis.

Methods: A cross sectional study had done upon 86 meningitis children (10.75±1.67 months) admitted at 2 referral hospitals (Rasoul Akram & Bahrami) in Tehran. CSF samples were obtained from 104 patients with suspected meningitis and examined for the presence of invading pathogens, changes in CSF with blood cell counts and protein and/or glucose concentrations. Based on CSF parameters (CSF culture /or universal PCR), 27 patients; were diagnosed as having bacterial meningitis and 59 patients had aseptic meningitis. All CSF samples were assayed for HSP70 using quantitative ELISA. The HSP70 level in CSF was measured to analysis the results, Mann-Whitney test was used. A ROC curve was constructed to illustrate various cut-offs of CSF-HSP70 levels.

Results: Area under ROC curve was 0.948; CSF– HSP70 Cutoff level 0.39 pg/dl had 96% sensitivity and 77% specifity; 89% PPV for differentiating the bacterial meningitis. CSF-HSP70 level in bacterial meningitis was significantly higher than viral meningitis (P=0.000) It was related to sex (P=0.05) of patients but not related to their ages.

Conclusion: CSF-HSP70 level has a high PPV (89%), good sensitivity (96%) and moderate specifity (77%) in differentiation of bacterial meningitis. Adding the CSF-HSP70 level as a complementary test to other conventional CSF tests is so useful in diagnosis of bacterial meningitis especially in meningitis cases that received antibiotic treatment before admission or partially treated meningitis.