Utility of Urine Reagent Strips in CSF Analysis as An Aid to Rapid Diagnosis of Meningitis
Keywords:
Cerebrospinal fluid, meningitis, urine reagent strip, Accuracy
Abstract
Background: Bacterial Meningitis is a medical emergency and timely intervention has an implication on the prognosis and outcome. Examination of the CSF for leucocytes, glucose and proteins are the cornerstones in the diagnosis of meningitis in general and to arrive at the cause. Hence, this study is done to evaluate the usefulness of urinary reagent strip for rapid diagnosis of meningitis. Methods: This is a prospective single blinded study on 100 CSF samples subjected to index test (Urine reagent strip test-Dirui H10) and definitive test comprised of CSF microscopy and biochemical analysis for proteins and sugar. The diagnostic accuracy of each index test at different cut off levels tabulated in the form of sensitivity, specificity, PPV and NPV. Result: The sensitivity and specificity for leukocytes by the strip method for ≥15 cells/cumm were 92% and 98.66%, and for protein levels >30 mg/dl were 84.33% and 94.11% respectively. The test showed high specificity (100%) but less sensitivity for glucose <50mg/dl. It was observed that the accuracy of the tests increased with increase in the values of cell counts and proteins and decrease in sugar reaching 100% accuracy for higher cut-offs. Conclusion: Urine reagent strip can be utilized for the rapid analysis of CSF in both rural areas as well as in centres where the facility is available as it reduces turnaround time.References
1. Jayaraman Y, Veeraraghavan B, Chethrapilly Purushothaman GK, Sukumar B, Kangusamy B, Nair KapoorA, et al. (2018) Burden of bacterial meningitis in India: Preliminary data from a hospital based sentinel surveillance network. PLoS one 13(5): e0197198.
2. McIntyre PB, O'Brien KL, Greenwood B, van de Beek D. Effect of vaccine on bacterial meningitis worldwide. The Lancet 2012 Nov 10; 380 (9854):1703±11.
3. Zunt JR, Kassebau NJ, Blake N, Glennie L, Wright C, Nicholas E, Abd-Allah F, Abdela J, Abdelalim A, Adamu AA, Adib MG. Global, regional and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology.2018 Dec 1;17(12):1061-82.
4. Bhat A, Roy R, T Umashankar, C S Jayaprakash. Rapid Diagnosis of Bacterial Meningitis by Urine Reagent Strip Testing of Cerebrospinal Fluid. J Med Sci Health 2018;4(1):15-17.
5. Mazumder S, Ramya BS, Biligi DS. Utility of urine reagent strips in cerebrospinal fluid analysis: An aid to bedside diagnosis of meningitis. Indian J Pathol Microbiol 2018;61:356-9.
6. Chikkannaiah P, Benachinmardi KK, Srinivasamurthy V. Semi‑quantitative analysis of cerebrospinal fluid chemistry and cellularity using urinary reagent strip: An aid to rapid diagnosis of meningitis. Neurol India 2016;64:50‑5.
7. Abdelmotaleb GS, Abdo MK, Behiry EG, et al. Evaluation of Using Urine Reagent Strips in the Diagnosis of Childhood Meningitis. Ann Clin Lab Res. 2016, 4: 3.
8. Romanelli RM, Thome EE, Duarte FM, Gomes RS, Camargos PA, Freire HB. Diagnosis of meningitis with reagent strips. J Pediatr(Rio J)2001;77:203‑8.
9. Gupta A, Dwivedi T. Reagent strips test: A Simplified method for prompt analysis of cerebrospinal fluid in neurological disorders in emergency. Practical laboratory medicine. 2019 Aug 1;16: e00124.
10. Joshi D, Kundana K, Puranik A, Joshi R. Diagnostic accuracy of urinary reagent strip to determine cerebrospinal fluid chemistry and cellularity. J Neurosci Rural Pract 2013;4:140‑5.
2. McIntyre PB, O'Brien KL, Greenwood B, van de Beek D. Effect of vaccine on bacterial meningitis worldwide. The Lancet 2012 Nov 10; 380 (9854):1703±11.
3. Zunt JR, Kassebau NJ, Blake N, Glennie L, Wright C, Nicholas E, Abd-Allah F, Abdela J, Abdelalim A, Adamu AA, Adib MG. Global, regional and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology.2018 Dec 1;17(12):1061-82.
4. Bhat A, Roy R, T Umashankar, C S Jayaprakash. Rapid Diagnosis of Bacterial Meningitis by Urine Reagent Strip Testing of Cerebrospinal Fluid. J Med Sci Health 2018;4(1):15-17.
5. Mazumder S, Ramya BS, Biligi DS. Utility of urine reagent strips in cerebrospinal fluid analysis: An aid to bedside diagnosis of meningitis. Indian J Pathol Microbiol 2018;61:356-9.
6. Chikkannaiah P, Benachinmardi KK, Srinivasamurthy V. Semi‑quantitative analysis of cerebrospinal fluid chemistry and cellularity using urinary reagent strip: An aid to rapid diagnosis of meningitis. Neurol India 2016;64:50‑5.
7. Abdelmotaleb GS, Abdo MK, Behiry EG, et al. Evaluation of Using Urine Reagent Strips in the Diagnosis of Childhood Meningitis. Ann Clin Lab Res. 2016, 4: 3.
8. Romanelli RM, Thome EE, Duarte FM, Gomes RS, Camargos PA, Freire HB. Diagnosis of meningitis with reagent strips. J Pediatr(Rio J)2001;77:203‑8.
9. Gupta A, Dwivedi T. Reagent strips test: A Simplified method for prompt analysis of cerebrospinal fluid in neurological disorders in emergency. Practical laboratory medicine. 2019 Aug 1;16: e00124.
10. Joshi D, Kundana K, Puranik A, Joshi R. Diagnostic accuracy of urinary reagent strip to determine cerebrospinal fluid chemistry and cellularity. J Neurosci Rural Pract 2013;4:140‑5.
Published
2020-07-07
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