الفهرس 
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Abstract
Despite the advances in diagnosis and treatment of infectious diseases, meningitis is still considered as important causes of mortality and morbidity. Early diagnosis and starting immediate empirical therapy are the key factors to reduce the morbidity and mortality related to bacterial meningitis (Taskin et al., 2010). Clinical criteria, Gram staining and bacterial antigen testing of CSF as well as the classic biological markers in the blood (CRP level, WBC count and neutrophil count) or CSF (protein level, glucose level, WBC count and neutrophil count) used alone do not offer 100% sensitivity with high specificity for distinguishing bacterial and aseptic meningitis (Dubos et al., 2008). Aim of the study: The aim of the present study was to evaluate causes of meningitis in Menoufiya governorate as well as using serum and CSF-cortisol level in discrimination between septic meningitis and aseptic meningitis. Patients and methods: A total of 90 patients finally diagnosed as meningitis were selected from inpatients of Menoufiya fever hospitals, Menoufiya Governorate in the period from January, 2010 to January, 2011. Patients and control subjects were classified into the following groups according to aetiology of disease. Group I: comprised of sixty patients with septic meningitis Group II: comprised of thirty patients with aseptic meningitis. Group III (Control group): comprised ten persons of matched age and sex selected from patients undergoing spinal anaethesia for various non CNS surgical problems as control group. These persons were free from clinical evidences of any CNS disease including symptoms and signs of meningeal irritation. All patients and control groups were subjected to the following:‐ Thorough history, clinical examination and laboratory investigations including complete blood count, ESR and CRP, blood chemistry including random blood glucose ,liver function tests (ALT, AST and serum bilirubin) and renal function tests (Blood urea and serum creatinine), CSF analysis (physical examination, chemical, cellular and bacteriological investigations) and measurement of serum and CSF cortisol levels, tuberculin test and radiological investigations including chest radiography, brain imaging (CT scan or MRI) studies when indicated. Statistical analysis of the results revealed: • No statistical significant differences among the studied groups as regarding age and sex. • Symptoms of meningitis were present in various proportions in the different patients groups. Fever was the most frequent symptom followed by headache, vomiting and photophobia with no statistical significant difference among the studied groups. • Signs of meningeal irritation, rash, convulsion and confusion were present in various proportions of patients with no statistical significant differences among the studied groups. • Highly significant rise of ESR, serum CRP and total leukocyte count in patients with septic meningitis. • Highly significant increase in tension of CSF in the majority of group I patients and group II patients when compared to group III patients.CSF turbidity was highly significant in group I patients when compared to other groups. • Highly significant increase in CSF-protein & CSF–total leucocytic count (TLC) and highly significant decrease in CSF – glucose in group I patients when compared to other groups, as well as in group II patients when compared to control group. More over CSF-PMN cells were predominant in group I patients, while CSF- mononuclear cells were predominant in group II patients. • Statistical analysis revealed highly significant increase in the mean value of serum & CSF cortisol level in group I when compared to other groups and in group II when compared to group III. • At threshold of 43.5nmol/l, a specificity of 100% and a sensitivity of 83.3% for the CSF cortisol test for discriminating septic meningitis patients from aseptic meningitis patients were detected. • At threshold of 337.5nmol/l, a specificity of 83.3%and a sensitivity of 96.7% for the serum cortisol test for discriminating bacterial meningitis patients from aseptic meningitis patients were detected. • Highly statistical significant relationship between CSF cortisol levels and Serum cortisol, CSF-protein, CSF-glucose and CSF- total WBCs was found. • Gram stain revealed the presence of organims in 39 cases (65%) of group I patients and absence of organisms in all of group II, group III and 21 cases (35%) of group I patients. while Z.N. stain was positive in 2 patients of group II. • Positive CSF-culture present in (78.33%) of group I patients and commonly detected organisms were St. pneumoniae (gram positive cocci) in 23 patients (38.33%), N. meningitidis (gram negative diplococci) in 15patients (25%), H. influenzae (gram negative pleomorphic rods) in 6 patients (10%).Staph. aureus and E. coli were the least common organisms with the incidence of(3.33%) and (1.7 %) respectively. • Acute recurrent meningitis was present in3 of patients of septic meningitis (one was secondary to chronic otitis media, one was secondary to fracture base of the skull and the third was secondary to hyderocephalus with shunt operation. • TB meningitis represents 6.7% of patients with aseptic meningitis. TBM in these patients was diagnosed by positive CSF–ZN and positive tuberculin test (induration area > 15mm). • Patients with septic meningitis were more frequent than patients with aseptic meningitis. However, death and complication were more frequent in patients with aseptic meningitis.