Ability of Procalcitonin and C-Reactive Protein for Discriminating between Bacterial and Enteroviral Meningitis in Children Using Decision Tree

Biomed Res Int. 2021 Aug 2:2021:5519436. doi: 10.1155/2021/5519436. eCollection 2021.


Bacterial meningitis (BM) is a public health burden in developing countries, including Central Asia. This disease is characterized by a high mortality rate and serious neurological complications. Delay with the start of adequate therapy is associated with an increase in mortality for patients with acute bacterial meningitis. Cerebrospinal fluid culture, as a gold standard in bacterial meningitis diagnosis, is time-consuming with modest sensitivity, and this is unsuitable for timely decision-making. It has been shown that bacterial meningitis differentiation from viral meningitis could be done through different parameters such as clinical signs and symptoms, laboratory values, such as PCR, including blood and cerebrospinal fluid (CSF) analysis. In this study, we proposed the method for distinguishing the bacterial form of meningitis from enteroviral one. The method is based on the machine learning process deriving making decision rules. The proposed fast-and-frugal trees (FFTree) decision tree approach showed an ability to determine procalcitonin and C-reactive protein (CRP) with cut-off values for distinguishing between bacterial and enteroviral meningitis (EVM) in children. Such a method demonstrated 100% sensitivity, 96% specificity, and 98% accuracy in the differentiation of all cases of bacterial meningitis in this study. These findings and proposed method may be useful for clinicians to facilitate the decision-making process and optimize the diagnostics of meningitis.

MeSH terms

  • Biomarkers / blood
  • C-Reactive Protein / cerebrospinal fluid
  • C-Reactive Protein / metabolism*
  • Child
  • Child, Preschool
  • Clinical Decision-Making / methods
  • Decision Trees
  • Diagnosis, Differential
  • Enterovirus Infections / blood
  • Enterovirus Infections / diagnosis*
  • Female
  • Humans
  • Infant
  • Machine Learning
  • Male
  • Meningitis, Bacterial / blood
  • Meningitis, Bacterial / diagnosis*
  • Meningitis, Viral / blood
  • Meningitis, Viral / diagnosis*
  • Procalcitonin / blood*
  • Procalcitonin / cerebrospinal fluid
  • Sensitivity and Specificity


  • Biomarkers
  • Procalcitonin
  • C-Reactive Protein