الفهرس 
EpidemiologyOnly 14 pages are availabe for public view
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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 clinical course of bacterial and viral meningitis is sometimes difficult to predict. Although the diagnosis of bacterial and viral meningitis mainly relies on the analysis of cerebrospinal fluid (CSF), only limited data on the prognostic value of CSF parameters exist. Yet, initial risk assessment of individual patients is of paramount importance in order to choose the appropriate level of further surveillance i.e. general ward versus critical care unit.
The aim of the present study was to evaluates the predictive power of IgG-index as CSF biomarker for disease prognosis in patients with bacterial and viral meningitis. Also, to evaluates the potential role of IgG-index in differentiation between bacterial and viral meningitis.
For this purpose, 40 patients were selected from emergency department of Embaba fever hospital with clinical presentations of suspected acute meningitis, and CSF analysis suggestive of meningitis during the period from September 2011 to January 2012. They were classified retrospectively after CSF study into 2 groups: group (1) comprised 20 patients with acute bacterial meningitis, group (2) comprised 20 patients with acute aseptic meningitis.
All patients were subjected to clinical study including full medical history and complete clinical examination for all systems including nervous system with special stress on symptoms and signs of acute bacterial and viral meningitis, routine laboratory study including CBC, ESR, CRP, ALT, AST, total proteins, serum albumin, serum creatinine, blood urea and random blood glucose, LP and CSF examination including: [a] aspect, color and tension of CSF. [b] CSF total and differential leucocyte count. [c] CSF protein and glucose level. [d] CSF/serum glucose ratio. [e] Bacteriological examination: Gram’s stain, Z.N stain and CSF culture. [f] CSF/serum albumin quotient (Qalb). [g] IgG index (CSF/serum IgG ratio): Intrathecal IgG synthesis will be measured using radial immunodiffusion (RID) technique. This index represents the CSF/serum IgG ratio in relation to Qalb.
Acute bacterial meningitis usually present with acute onset and aseptic meningitis usually present with subacute onset, as there was a high statistically significant difference in duration of symptoms between both patients groups with shorter duration of symptoms in septic group.
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 headache and meningeal signs.
The bacterial group characterized by increased CSF WBCs, polymorph predominance, highly elevated CSF protein, reduced CSF glucose and CSF/serum glucose ratio ≤ 0.4 in most patients. While the aseptic group characterized by mononuclear cell pleocytosis with nearly normal CSF glucose, normal or slightly elevated CSF protein and CSF/serum glucose ratio > 0.4 in most patients.
In bacterial meningitis, the detected bacteria were S. pneumoniae in 9 patients (45%), N.meningitides in 2 patients (10 %) and H. influenzae in 2 patients (10 %). There was no detected bacteria in 7 patients (35%).
There is a high statistically significant difference in CRP, serum TLC and polymorphs between both patients groups with higher values in bacterial group than the aseptic group. While, there is no significant difference in ESR, Hb concentration and platelets count.
There is no statistically significant difference in serum IGg and IGg index between both patients groups (P > 0.05). The best cut off value of IgG index for early diagnosis of bacterial meningitis was 5.62 with AUC of 0.525 and 95% CI of 0.343-707 and sensitivity of 60% and specificity of 50%.
The IgG-index was the only independent predictor for unfavorable outcome (GOS < 5) in patients groups especially viral group. There is no significant association between unfavorable outcome and all other studied parameters. The best cut off value of IGg index for early prediction of unfavorable outcome (GOS < 5) in bacterial meningitis group was ≥ 6.745 with AUC of 0.922 and 95% CI of 0.769-1.07 and sensitivity of 75% and specificity of 93.7%. Also, the best cut off value of IgG index for early prediction of unfavorable outcome (GOS < 5) in viral meningitis group was ≥ 7.9 with AUC of 1 and 95% CI of 1.00-1.00 and sensitivity of 100% and specificity of 100%.