2 to 4 mmol/L with a sensitivity of 78% to 100% and a specificity of 96% to 100% [29-31]. In our study, with a diagnostic cut-off value of 3.8 mmol/L, the sensitivity for the differential diagnosis of BM was 94%, with a specificity of 97%. This was one of the two parameters that http://www.selleckchem.com/products/carfilzomib-pr-171.html discriminated best between BM and VM in our study, based on comparisons between the different ROC curves. The most recent French consensus conference on the management of BM emphasizes the value of this marker [32].The value of serum levels of C-reactive protein, a protein characteristic of the acute phase of inflammation, in differentiating BM and VM, was investigated in several published studies, as well as in a meta-analysis (including 14 studies in which serum levels of C-reactive protein were measured) [17,26,33-35].

The cut-off levels for the differential diagnosis of BM ranged from 20 to 100 mg/L [35]. The best compromise between sensitivity and specificity seemed to be achieved at diagnostic cut-off levels between 20 and 50 mg/L, although even in this case, the sensitivity and specificity were still less than 80%, notably with regard to adult patients with acute meningitis and a negative direct CSF examination [17]. In our study, the contribution of serum C-reactive protein to the diagnosis of BM was inferior to that of CSF protein and lactate and serum PCT, with a sensitivity of 86% and a specificity of 84% at a diagnostic cut-off level of 37 mg/L.PCT is another marker that has been evaluated with regard to its usefulness in distinguishing between infections of bacterial and viral origin.

Serum levels of this marker increase within 2 hours after stimulation of inflammatory processes, as shown in healthy volunteers receiving an injection of lipopolysaccharides [36]. The first studies on PCT in the context of BM, in adults and children, were published in 1997 and 2000 [9,31,37,38]. Serum PCT was found to be capable of differentiating BM (23 cases in children and 32 in adults) from VM in 100% of cases, but the diagnostic cut-off levels used ranged from 0.20 ng/ml to 2 ng/ml. Other studies subsequently completed these data in adults with conflicting results. In the study reported by Schwarz et al. [39], among 16 patients with BM, five showed serum PCT levels < 0.5 ng/ml, the bacterial species identified in these patients being Mycobacterium tuberculosis (one), Borrelia burgdorferi (one), Staphylococcus aureus (one), Haemophilus influenzae (one), and Streptococcus Dacomitinib pneumoniae (one). The sensitivity of this parameter for the differential diagnosis of BM was 69%, and the specificity was 100% at a diagnostic cut-off level of 0.5 ng/ml. In another study on 12 patients with BM, reported by Hoffmann et al.