الفهرس 
MeningitisOnly 14 pages are availabe for public view
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Abstract
_________ <”l SUMMARY AND CONCLUSION ro -103-
SUMMARY AND CONCL.USION
Despite advances in medical technology and the development of
new antibiotics, including the 3rd generation cephalosporins the overall
mortality and morbidity of bacterial meningitis have remained unchanged
for the past 3 decades. Case fatality rates are 3-7% in infants and children
(Saez et al., 1990) and as many as one-third of survivors suffer long-term
neurological sequelae. A recent hypothesis regarding morbidity in bacterial
meningitis focuses on cytokine activity in the central nervous system and
the possibility of reducing morbidity and mortality by modulation of the
host inflanunatory response. The cytokine levels reflect the degree of
inflammatory response and are positively correlated with the severity of
acute clinical complications, modulation of thin inflammatory response in
bacterial meningitis may improve its morbidity and mortality (Low et al.,
1995)-. Because of the necessity· of immediate therapy, the result ofCSF
cultures can not be awaited, and these results may even be observed if the
patient had received antibiotic treatment before hand (Balzer et al., 1983).
The aim of this work is : . To measure IL -6 111 CSF and plasma in children with bacterial or
viral meningitis, and to determine whether the initial CSF or plasma
concentration ofIL-6 correlate with clinical presentation or with outcome.
The study was carried out on 50 children categorized into 5 group
acute bacterial meningitis, acute non bacterial (presumed viral) meningitis,
tuberculus meningitis, partially treated bacterial meningitis and control
group.
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_________ C’i/. SUMMARY AND CONC/,USION ,., ___ -104-
In the present study IL-6 was present in CSF of all cases with
bacterial meningitis at time of admission, CSF IL-6 level in bacterial group
was significantly higher than that of (viral - T.B and control group) but, it
was insignificantly differ than that of partially treated bacterial group. All 4
!,’TOUpS significantly higher than control group.
Plasma IL-6 of all 4 groups not significantly different from each
other, but all of them significantly higher than control.
’CSF cultures of 14 bacterial cases showed that 6 cases haemophi1us
intluenzae, 7 cases of N. meningitidis and 1 case with st. penumoinae
orgamsm.
CSF culture of7 cases of tuber cuius meningitis group show positive
growth on Lewenstein jensen media.
In the present study, positive significant correlation was found
between CSF IL-6 and CSF cells, and negatively correlated with CSF
chloride concentration.
Also, 111 the present study there was positive significant correlation
between CSF IL-6 & serum CRP. There was no significant correlation
between CSF lL-6 and plasma lL-6 and the level oflL-6 in CSF was much
more higher than the plasma IL-6 level.
There was still high level of CSF IL-6 in partially treated bacterial
group who take l.V. antibiotic from (2-4) day of admission.
_________ C>! SUMMARY AND CONCLUSION I”J -105-
In the present study CSF IL-6 was correlated with the presence of
coma of bad prognosis during the admission.
from this study we concluded that:
CSF IL-6 levels may help in differentiation between bacterial and
non bacterial meningitis groups in young infants and the presence of IL-6
in CSF was uniformly sensitive in the prediction of bacterial meningitis,
Although, the discrepancies between the levels of CSF IL-6 in the different
groups of meningitis, this were not significantly enough to allow us to
define a cutoff value reliably identifying bacterial meningitis.
Detection of CSF IL-6 is more likely to be due to local production
rather than a reflection of increased plasma levels.
Serum CRP (C- reactive protein) was related to level of CSF IL-6,
so CRP in serum is of value in prediction of increased level ofCSF IL-6
in bacterial meningitis.
Also, CSF IL-6 was very high in cases with acute clinical
complication (coma), so, it is beneficial in predicting the outcome.
We recommended:
Further studies with larger sample to allow us to define a cut off
value reliably identifying bacterial meningitis & to explore the clinical
application of these observation in the different groups of meningitis and
use it as a predictive value of prognosis