الفهرس 
MeningitisOnly 14 pages are availabe for public view
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Abstract
SUMMARY
differentiating viral meningitis from bacterial meningitis will remain a challenging task in order to accurately evaluate the type of meningitis and for therapeutic decision making for acute meningitis. The symptoms and laboratory assays are often similar and overlapping, death is not uncommon and many who survive are left permanently disabled .
In order to differentiate aseptic meningitis to the bacterial meningitis, numbers of studies have shown the effectiveness of rapid and definite tests using CSF variables and markers of peripheral blood for various common and uncommon laboratory measurements.
The present cross sectional study was designed in an attempt to assess the validity and role of using CSF LDH and lactate as a markers for differentiating BM from VM.It included 40 children with ages ranging between 2 months to 17 years and a mean age of 6.6 years. They were 28 males (70%) and 12 females (30%). They were recruited from Abbassia Fever Hospital in the period from August 2013 to January 2014 with the diagnosis of meningitis.They were grouped according to their final diagnosis into two groups. The first group included 18 patients with the diagnosis of bacterial meningitis according to their clinical picture and laboratory test results. The second group included 22 patient with viral meningitis.
All studied patients were subjected to full clinical evaluation including detailed history taking (personal history, presenting complaint, general symptoms and neurological symptoms stressing on disturbed conscious level, seizures, increased intracranial pressure and symptoms of meningeal irritation).
All studied patients subjected to full clinical examination including general and detailed neurological examination.
Laboratory investigations were done as CBC with differential count, ESR and CRP.Cerebrospinal fluid examination also done in the form of:
•Physical examination.
•Biochemical analysis for protein and sugar.
•Cytological examination.
•Bacteriological examination.
•LDH and lactic acid level measurement.
All patients were clinically and laboratory reevaluated at day3-7 for follow up and detect the response to treatment.
•Regarding age, gender and socio-demographic parameters, there were no significant differences between the two groups.
•As regard presenting complain and signs of meningeal irritation: Neck rigidity, Kernig’s and Brudzinski’s signs, there were non-significant difference among children with BM compared to those with VM.
Regarding the Glascow coma scale (GCS) at presentation, frequency of GCS degree (9-14) was significantly high among patients with BM compared to VM.
As Regard the hematological parameters: TLC and neutrophils were significantly higher in BM compared to VM but lymphocytes was significantly higher in VM. ESR and CRP were significantly higher in BM.
• Regarding the CSF parameters, Patients with BM had a significantly higher mean of CSF WBC with polymorphs predominating compared to those with VM. while lymphocytes predominating in VM. The biochemical CSF results showed that CSF glucose and CSF/ serum glucose ratio were significantly lower in BM compared to VM. The mean CSF protein concentration was significantly higher in BM than VM. In our study we found that CSF/ serum glucose ratio at a cutoff value of >0.39 can be used for differentiating BM from VM with 86.4%sensitivity and 100% specificity.
•CSF LDH level and CSF lactate concentration was significantly higher among patients with BM than patients with VM. The results of the present study showed that CSF LDH level at a cutoff value of ≥97.75U/L has a sensitivity of 100% and specificity of 100% for differentiating BM from VM and CSF lactate level at a cutoff value of ≥3.91mmol/L has a sensitivity of 94.4% and specificity of 95.5% for differentiating BM from VM.
•As regard the prognosis of the disease among our patients, The results of the present study showed a significantly higher mean CSF LDH and lactate level among patients with morbidity and mortality compared to those with complete recovery. CSF LDH level at a cutoff value at ≥ 115.2U/L indicates morbidity and mortality with 75% sensitivity and 75% specificity.
•CSF lactate level at a cutoff value at ≥ 4.88 mmol/L indicates morbidity and mortality with 75% sensitivity and 82.1% specificity.
In our study all patients were clinically and laboratory reevaluated at day3-7 for follow up and detect any improvement and the response to treatment we found that CSF LDH and lactate level were dropped after adequate treatment, our finding clearly support an association of appropriate treatment, clinical improvement and normalization of CSF LDH and lactate level