Rapid diagnosis of bacterial meningitis with reagent strips

Laboratory examination of cerebrospinal fluid (CSF) is not available in many parts of the world, and without knowledge of CSF glucose, protein, and cells, a diagnosis of meningitis may be missed. Testing CSF with urine reagent strips that measure glucose and protein has given variable results. We tested CSF samples from 234 children with suspected meningitis for glucose, protein, and leucocytes with Combur9 reagent strips. The results were compared with those obtained from the laboratory and also interpreted as indicating bacterial or viral meningitis. There was good agreement between the strip and laboratory method of estimating CSF glucose, protein, and leucocytes. All but 4 of the cases of meningitis were correctly identified by the strip method (sensitivity 97%). 2 (2·9%) of 69 cases of bacterial meningitis were judged by an independent observer to be viral, and 2 (3·3%) of 60 cases of viral meningitis as normal. No normal CSF was diagnosed as meningitis (specificity 100%). The results indicate that Combur9 reagent strips can distinguish normal from infected CSF and are of value in the diagnosis of meningitis.