الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
 |  | from | 162 |  |  |
| | | from | 162 | | |
Abstract
SUMMARY AND CONCLUSION
A
cute bacterial meningitis is at least ten times more common in developing countries than in the rest of the world and is almost always fatal without treatment. Survival depends on accurate diagnosis and the early administration of antibiotics.
Despite the advances in diagnosis and treatment of infectious diseases, meningitis and encephalitis are still considered to be important causes of mortality and morbidity. In efforts to decrease the morbidity and mortality related to bacterial meningitis, having an early diagnosis and starting immediate empirical therapy are the key factors. In the early phases of acute bacterial and viral meningitis, signs and symptoms are often non-specific and it is not always possible to make a differential diagnosis on the basis of routine examination of cerebrospinal fluid (CSF).
The concentration of CSF lactate depends largely on production from CNS glycolysis and is independent of serum lactate.
Thus, the CSF lactate concentration has been suggested as a useful parameter to differentiate bacterial from aseptic meningitis. This study was designed to evaluate the role of CSF lactate concentration in differentiating bacterial from aseptic meningitis.
This study included 100 patients admitted to Abbassia Fever Hospital with the diagnosis of meningitis. They were grouped according to their final diagnosis into two groups. The first group included 59 patients with the diagnosis of bacterial meningitis according to their clinical picture and laboratory test results. The second group included 41 patients with aseptic meningitis.
All patients in the study were subjected to the following:
A-Thorough history taking:
- Full medical history taking including: headache, fever, vomiting, convulsion, altered mental status and drug history.
- History was taken from accompanied person if the patient could not give history.
B-Thorough clinical examination:
- Thorough clinical examination with special stress on the classic triad of fever, neck stiffness and a change in mental status. Other signs including Kernig’s and Brudzinski’s signs were done.
C-Laboratory Investigations include:
1- CBC with differential, ESR and CRP.
2- CSF examination.
• Physical examination.
• Bacteriological examination.
• Cytological examination.
• Biochemical examination for protein and sugar.
• CSF lactate level measurement.
Regarding age, gender and socioeconomic characteristics, there were no significant difference between the septic meningitis and aseptic meningitis.
As regard clinical symptoms and signs, patients with bacterial meningitis had significantly higher frequencies of signs of meningeal irritation compared to those with aseptic meningitis.
As for blood tests, patients with bacterial meningitis had significantly higher mean values of TLC, ESR and CRP. While those with aseptic meningitis had significantly higher mean percentage of lymphocytes.
Regarding CSF lab parameters, patients with bacterial meningitis had significantly higher mean values of WBCs count, percentage of polymorphnuclear cells and protein concentration in CSF and lower mean glucose concentration ,Lymphocytes percentage and CSF/serum glucose ratio.
Patients with bacterial meningitis had significantly higher mean CSF lactate concentration with significantly higher frequency of CSF lactate above the normal range. CSF lactate at a cutoff value of >32 has Sensitivity of 94.9% and Specificity of 100% for differentiating bacterial meningitis from aseptic meningitis.
In conclusion
This study showed that the CSF lactate level was significantly high in bacterial than aseptic meningitis and can provide pertinent, rapid and reliable diagnostic information. Furthermore, CSF lactate level can also differentiate bacterial meningitis from viral meningitis in a quick and better way. However, it has also been suggested that CSF lactate determination should not replace the conventional tests for meningitis.
We found in this study that CSF lactate can be used as a rapid accurate diagnostic test for differentiating bacterial from aseptic meningitis in Egyptian patients.