الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
Meningitis is an extremely severe and life threatening infection that necessitates immediate diagnosis and prompt therapy. The delay in the diagnosis and the consequent delay in initiation of treatment can cause death in about 10% of cases with advanced disease and severe neurological sequelae as many as 80% of survivors. The aim of this work was to study the prevalence of neurological complications and outcome in patients with acute meningitis and its correlation with IgG index.For this purpose 90 patients with clinical suspicion of meningitis presented to Shebin Elkom fever hospital were chosen in the period between June 2014 and April 2015.These patients were classified according to the etiology into two groups based on clinical and laboratory findings as follow: group (1) comprised of 53 patients with acute aseptic meningitis. group (2) comprised of 37 patients with acute septic meningitis. All patients in the study were subjected to the following: 1. History taking. 2. Full general and clinical examinations with special stress on signs of meningitis (Neck rigidity, kerning’s and Brudhzinski signs). 3. Laboratory investigations including CBC, ESR, CRP, ALT, AST, total proteins, serum albumin, serum creatinine, blood urea, random blood glucose level and serum IgG. 4. CT brain.
5. Lumber punctur and CSF examinations including: [a] Aspect, colour and tension of CSF. [b] CSF total and differential leucocyte count. [c] CSF protein and glucose level. [d] CSF albumin. [e] CSF IgG [f] Bacteriological examination: Gram’s stain and CSF culture. IgG index = (CSF IgG / serum IgG) / (CSF albumin /serum albumin) 6. Glasgow outcome scale (GOS) was done at discharge .The duration of hospital stay was recorded. Results of the presenting data revealed: Fever was a universal finding in all patients of meningitis. Differentiation between septic and aseptic meningitis on clinical bases was difficult; as there was no statistically significant difference in all signs and symptoms except for coma and neck stiffness. The bacterial group characterized by increased CSF WBCs, polymorph predominance, highly elevated CSF protein and reduced CSF glucose. The statistical analysis revealed that, the gram stain showed no bacteria in 59.5% of bacterial cases and the detected bacteria were Meningococci in 6 patients (16.2%), pneumococci in 5 patients (13.5%),Proteus in 2patients (5.4%) and Staphylococci in 2 patients (5.4%). There was a high statistically significant difference in CRP, serum TLC and polymorphs between both patients groups with higher values in bacterial group than aseptic group. Improvement of 51 patients (96.2%) and complications in 2 patients (3.8%) in aseptic group. Whereas, there was
improvement of 25 patients (67.6%) and complications in 12 patients (32.4%) 6 of them (16.3) were died in septic group. The neurological complications in aseptic group were motor affection in 2 patients (3.8%) and cranial nerve palsy in 1 patient (1.9%). The neurological complications in septic group were hydrocephalus in 4 patients (10.8%) and motor affection in 7 patients (18.9%), subdural empyma in 1 patient (2.7%), epilepsy in 2 patients (5.4%), brain abscess in 2 patients (5.4%) and deafness in 2 patients (5.4%) Prevalence of neurological complications in all cases of meningitis in this study was 15.6% There was high statistically significant difference in outcome between both patients groups with improvement in 51patients (96.2%) and complications in 2 patients (3.8%) in aseptic group, whereas, there was improvement in 25 patients (67.6%) and complications in 12 patients (32.4%), 6 (16.3%) of them were died in septic group. There was no statistically significant difference in IgG index between both patients groups (P > 0.05). But there was highly statistically significant difference in IgG index in patients with complications and patients without complications (P <0.001). The best cut off value of IgG index for early prediction of complications in viral meningitis group was ≥ 0.74 with AUC of 0.68 and sensitivity of 75%, specificity of 65% and diagnostic accuracy of 66.3%. There was no significant
association between unfavorable outcome and all other studied parameters. The best cut off value of IgG index for early prediction of complications in bacterial meningitis group was ≥ 0.76 with AUC of 0.74 and sensitivity of 81.8%, specificity of 60% and diagnostic accuracy of 73%. The best cut off value of IgG index for early prediction of complications in all studied patients was ≥ 0.75 with AUC of 0.73 and sensitivity of 89%, specificity of 64% and diagnostic accuracy of 71.1%.