الفهرس 
MeningitisOnly 14 pages are availabe for public view
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Abstract
It is important to distinguish bacterial meningitis from aseptic meningitis during the acute phase of the disease, when clinical symptoms are often similar. This could help to avoid complications and to limit unnecessary antibiotic use.
To date, neopterin and/or C3 levels of serum and/or CSF and combination of both in diagnosis of septic and aseptic meningitis have not been evaluated in Egypt.
The aim of the current study was to evaluate the potential diagnostic role of Serum and CSF neopterin and/or C3 levels in differentiation between septic & aseptic meningitis. As well as to assess the combination of both, as a rapid diagnostic method for differential diagnosis of septic and aseptic meningitis.
For better assessment, this study was designed to be a cross sectional study. The current study included 40 patients who were diagnosed as meningitis according to the pre-designed inclusion criteria.
In the present study, There was no significant difference as regards to the age and sex and clinical presentation in the studied groups.
There was a statistically significant difference in the duration of symptoms between both groups (P < 0.001) with shorter duration of symptoms in septic group. Also there was a highly significant difference in the duration of hospitalization between both groups (P < 0.001).
Regarding to the laboratory findings, TLC, neutrophils, lymphocyte, platelets, erythrocyte sedimentation rate and C reactive protein were higher in septic group than aseptic group with a statistical significant difference (P<0.001) but no significant difference could be elicited regarding Hb(P>0.05).
Concerning CSF examination, there was higher WBCs, polymorphs% and protein levels of CSF and lower CSF glucose in septic group than aseptic group with a statistically highly significant difference (P< 0.001).
In bacterial meningitis group, the detected bacteria were S. pneumonia in 80%, N.meningitides in 15%, and H. influenzae in 5% of patients.
In aseptic meningitis group, there was only one patient with Aspergillus fungus.
In the present study, the mean CSF neopterin concentrations and C/S neopterin ratio were higher in patients with acute bacterial meningitis than in patients with aseptic meningitis, but without statistical significant difference (P>0.05). The mean serum neopterin concentrations were nearly in septic and aseptic meningitis.
Regarding serum C3, the mean concentrations were lower in septic than aseptic without statistically significant difference (P> 0.05). While C3 was not detected in the CSF of both groups by radioimmunoassay method.
The current study revealed that the combination of the previously measured parameter in diagnostic differentiation between septic and aseptic meningitis, combined elevated serum & CSF neopterin were efficient in diagnosis of septic meningitis with a highly statistically significant (P < 0.001).
The results also revealed that in aseptic cases there is a highly significant correlation between CSF neopterin and CSF/serum neopterin ratio (P<0.001), and a significant correlation between serum neopterin and each of age & CSF glucose in aseptic cases (P<0.05).
Regarding to the septic cases, there is a significant correlation between CSF neopterin and CSF/serum neopterin ratio (P<0.001), and a highly significant correlation between CSF neopterin and symptoms’ duration (P<0.001), as well as a significant correlation between serum neopterin and TLC (P<0.05). While, there is no correlation between C3 and neopterin in serum ansd/or CSF in both patients groups and other parameters as ESR, CRP, CSF glucose, CSF protein, CSF WBCs (P>0.05). Also, there is no correlation between serum and CSF neopterin in both patients groups (P>0.05).