الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Summary & Conclusion
SUMMARY & CONCLUSION
Bacterial meningitis remains an important cause of morbidity
and mortality despite substantial progress in diagnosis and treatment.
The traditional diagnostic methods of CSF Gram staining and
culture have, for many years, provided the clinicians with assistance
in the diagnosis of bacterial meningitis. Despite that an early correct
diagnosis may be obtained by visualisation of Gram-stained bacteria
on microscopic examination of CSF deposit, this way may be difficult
even in experienced hand and requires intact bacterial morphology.
Cultural methods may take up to 48-72 hours for identification of the
organism and bacteria must be viable, In addition, Gram-stained
smear and culture may fail to prove the aetiology in patients already
treated with antibiotics. Hence rapid tests for identification of
bacterial antigens have been developed. These tests include counter
immuno-electrophoresis, enzyme-linked immunosorbent assay,
coaglutination and latex agglutination tests.
The objective of the present study is to identify the aerobic
bacteria causing acute childhood meningitis in different ages and
sexes and to evaluate different methods used for diagnosis.
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Summary & Conclusion
This study was done on 35 patients admitted to meningitis ward
of Embaba Fever Hospital with signs and symptoms suggesting
meningitis during the period extending from February, 1997 to May,
1997.
All patients were subjected to lumbar puncture under complete
aseptic conditions and CSF WCJIS examined chemically,
bacteriologically by Gram staining and culture and serologically by
latex agglutination test.
The physical examination of the CSF was turbid in the 35 cases
and under tension.
The CSF chemical analysis by Comber’s reagent strips are of
value in rapid diagnosis of bacterial meningitis but without
identification of the causative organism.
The causative organisms were detected in 21 patients (60%), as
identified by latex agglutiliatination test. Gram-stained smear of CSF
and its culture detected the causative organisms in 22 (62.9%) and 30
(85.7%) cases respectively.
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Summary & Conclusion
Of these 35 cases, the causative organism was N.meningitidis in
20 cases (57.1 %), S.pneumoniae in 3 cases (8.67%), H.influenzae in
12 cases (34.3%).
Bacteriological examination of cerebrospinal fluid (CSF) is not
available in many parts of the world, and without knowledge ofCSF
glucose, protein, and white cells, a diagno~.is of septic meningitis may
be missed. Testing CSF Comber’s 9 reagent strips that measure
glucose, protein and leucocytes has given valuable results.
We tested CSF samples from our 35 children with suspected
meningitis for glucose, protein, and lecu<:ocytes with Comber’s 9
reagent strips. The results were compared with those obtained from
the laboratory and also interpreted as indicating bacterial meningitis.
There was good agreement between the strip and laboratory method of
estimating CSF glucose, protein, and leucocytes. All the cases had
low glucose and high protein and WBc contents by the strip method
(sensitivity 100%). No normal CSF was diagnosed as meningitis
(specificity 100%).
The results indicated that CSF chemical analysis and Comber’s
9 reagent strips are of value in rapid diagnosi~:of bacterial meningitis
but without identification of the causative organism.
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Summary & Conclusion
CONCLUSION
1- The clinical suspition of acute bacterial meningitis depends
on certain symptoms including fever, vomiting, irritability,
convulsions and purpuric rash.
2- A diagnosis of acute bacterial meningitis cannot be mad on
the basis of symptoms and signs alone but lumber puncture
should be done.
3- The physical criteria of bacterial meningitis include turbid
CSF with high tension.
4- Chemical analysis of C.S.F. of bacterial meningitis patients
shows decrease in glucose level <50 mg/dl and i”’~”ease in
protein values more than 100 mg/dl .
5- The comber’s 9 reagent strip is an easy, rapid and cheap
method for chemical analysis and diagnosis of bacterial
meningitis but cannot define the causative organism of
bacterial meningitis.
6- C.S.F latex agglutination test is also c. rapid and easy method
for diagnosing bacterial meningitis with organism detection and
should be routinely included in the methods of rapid diagnosis
of bacterial meningitis but are not meant to replace CSF culture.
7- The Gram stain of the CSF is a rapid method of diagnosis
with organism detection but because of the possibility of
misidentification,results of culture and latex agglutination
should be obtained.