الفهرس 
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Abstract
Bacterial meningitis remains a cause of morbidity and mortality in childhood all over the world despite the availability of effective
vaccination against many causative organisms as Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae in developed countries and some of developing countries.Aseptic (nonbacterial) meningitis is more common than the bacterial type but likely it is less dangerous and has better prognosis, and the most common cause is viruses.The purpose of this study was to analyze the data of meningitis cases among children, the clinical criteria of the disease, the methods of diagnosis, the most common causative organisms, the optimum treatment and the outcome of the treatment and the occurance of post infection sequale.This study was done on 60 pediatric patients admitted to EL Abbassia fever hospital with criteria of CNS infection. The patients were complaining of hyperthermia above 38c (100%), neck rigidity (98%) +ve Brudziniski’s and Kernig’s signs (98%), disturbed consciousness level ranged from lethargy and irritability up to deep coma and flaccidity,bulging fontanels, headache, vomiting (99%), and some patients had a
characteristic rash of the meningococcemia.All patients were subjected to the following:- Full history taking- Complete clinical examination with a stress on the CNS signs- Routine laboratory examination Liver enzymes (SGOT, SGPT).Summary and conclusions Page 86 Kidney function (blood urea, serum creatinine). Hemoglobin concentration. Peripheral white blood cells count. Random blood sugar.- Fundoscopg- Imaging if neede- Lumbar puncture- CSF examination- Empirical antimicrobial therapy According to the clinical criteria and the CSF examination using the cell count and type, CSF protein and glucose levels, gram stain and culture we categorized the cases into 2 groups
- Bacterial group (group I)
- Nonbacterial group (groupII)
RESULTS The bacterial group (group I):
- It included 31 patients, their ages ranged from 6 months to 17
years, and males to females ratio was 1,8 : 1.
- Cells count in this group ranged from 660 and up to 24760 cell/ml,
and in some cases it was uncountable. The type of the cells was
mainly PMNLs with a ratio of 90 % : 100 % in relation to the
lymphocytes.
- Protein level in the CSF was high in all cases of this group and was
ranged from 150 and up to 1330 mg/dl.
Summary and conclusions
Page 87
- Glucose level was low in most patients of this group in relation to
the blood sugar; normally the CSF glucose is 0.4 of the blood
glucose.
- The microbiological examination of the CSF yielded the presence
of microorganisms in 10 patients using the culture and in 2 patients
using the gram stain.
- Using the gram stain there were two patients yield organisms one
was gram – ve diplococci and the other was gram – ve rods.
- The cultures yield the presence of organism in 10 cases:
4 patients of Nisseria meningitidis
3 patients of Haemophilus influenza
2 patients of Strept pneumonia.
1 patients was gram -ve rods.
In the rest of patients there was no growth and this is explained by
early use of antibiotics before the initial lumbar puncture which sterilize
CSF early and lead to negative cultures.
In these cases of negative culture we relied on the clinical data and
the cell types and counts and the protein and glucose levels to diagnose
them as bacterial infection.
Bacterial Meningitis Score:
The patients had a very low risk for bacterial meningitis if all of
the following were absent: positive CSF gram stain, CSF absolute
neutrophil count (ANC) of ≥ 1000, CSF protein of ≥ 80 mg/Dl, a
circulating ANC of ≥ 10,000 cells / microliter (mcL), a seizure as part of
the presentation.
Summary and conclusions
Page 88
On applying this score in the present study we considered the
presence of 3 or more of the abnormal criteria as a bacterial meningitis
(100% in the culture positive patients) and (95,2% in the culture negative
patients).
The antimicrobial treatment was initiated just after the initial
lumbar puncture not waiting for the result of the examination and it was
in the form of ampicillin-ceftriaxone combination, and we use
dexamethasone in the first 3 days of treatment to decrease the
inflammatory reaction and decrease the post inflammatory complication.
After the culture results seen if specific antibiotics were used
according to the sensitivity results.
The nonbacterial group (group II):
- It included 29 patients with age ranged from 5 months to 17 years
old, and male to female ratio was 1,07 : 1.
- The symptoms and signs were milder in relation to the bacterial
group.
- Cells count in this group ranged from 10 to 520 cell/ml and they
were mainly lymphocytes.
- The Protein and the glucose levels were normal nearly in all
patients.
- The gram stain and culture done for all the cases of group II yield
no organisms.
- On applying the bacterial meningitis score on the group II
considering patients with less than 3 criteria as negative (100% of
patients were negative).
Summary and conclusions
Page 89
- In the treatment of these cases we used anti viral agents as zovirax
in combination with ampicillin and the prognosis was excellent.
Follow up of patients
- Clinical follow up for all cases:
Regaining consciousness level, fever subside, restored
suckling or oral feeding.
- Laboratory follow up by repeated lumbar puncture and CSF
examination as follow:
After 8 days for improving cases.
After 4 days for non improving cases.
Prognosis and outcome:
The non bacterial group:
The recovery was rapid and excellent in the nonbacterial group. All
cases were discharged after complete recovery and no complications.
The bacterial group:
The recovery was good in most cases but in other cases it was slow
with development of some complication.
from 31 patients, 26 patients were discharged after complete
recovery, 4 patients developed complications especially communicating
hydrocephalus, and only one patient died.Summary and conclusions