Estimation Of Csf Cortisol Levels In Patients With Meningitis - A One Year Cross-Sectional Study

Abstract

Background and objectives Increased CSF cortisol levels have previously been reported in various CNS disorders. The present study was planned to estimate CSF cortisol levels as a marker to differentiate the types of meningitis and to correlate CSF cortisol levels with severity. Methodology This one year cross-sectional study was carried out in the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. A total of 50 patients presenting with meningitis aged more than 18 years were studied. Results In the present study 56% were males and 44% were females with male to female ratio of 1.2:1. The commonest age group was 31 to 45 years with 54% of the patients and the mean age was 36.10 ± 13.21 years. The commonest presentation was fever (94%) followed by headache (80%) and vomiting (72%). Signs of meningeal irritation were present in all the patients (100%). Altered consciousness and cerebellar signs were present in 36% and 26% of patients respectively. Neck stiffness was present in all the patients (100%) while Kernig and Brudzinki sign was noted among 94% and 18% of the patients. 40% of the patients had tubercular meningitis and 26% of the patients had viral meningitis. In the remaining acute pyogenic meningitis was present in 22%, fungal in 8% and toxoplasmosis in 4%. Conclusion and interpretation In this study the mean CSF cortisol levels were high in patients with tubercular meningitis (34.50 ± 8.45) compared to toxoplasmosis (25.50 ± 3.54), Acute pyogenic (Bacterial) (25.00 ± 6.99), fungal (20.00 ± 4.32) and viral (16.00 ± 7.93). This difference was statistically significant (p<0.001). Of the 31 patients with bacterial meningitis, 74.19% had elevated CSF cortisol (p=0.007). Patients with APACHE II score between 25 to 35, all (100%) patients had raised CSF cortisol levels (p=0.041). Out of 13 patients, 30.77% patients of viral meningitis had elevated CSF cortisol.