الفهرس 
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Abstract
This prospective study was carried out in the central nervous system (CNS) Infection Department in Menouf Fever Hospital in the period between May 2014 to Augest 2014. A total number of 38 patients were selected from 60 patients attending to Menouf Fever Hospital their age ranged from 17 years up to 40 years in addition to 10 healthy control subjects.
They were classified retrospectively after CSF study into 3 groups:
Group 1: 19 patients with bacterial meningitis (11 males and 8 females), their age was ranged from (17-35 years) with mean age ± SD 23 ± 5 years old .
Group 2: 19 patients with aseptic meningitis (11 males and 8 females) their age was ranged from (19- 40 years) with mean age ± SD 27 ± 6 years old .
Group 3: 10 subjects (4 males and 6 females) , their age was ranged from (18- 30 years) with mean age ± SD 20 ± 5 years old . considerd as control group in whom CSF obtained during epilepsy or undergoing spinal anaesthesia for non CNS surgical problem.
The aim of this work was to evaluate level of IL-6 and High sensitive C Reactive Protein in cerebrospinal fluid and serum in acute bacterial and aseptic meningitis.
For this purpose, all patients and control subjects were subjected to thorough history taking, clinical examination, laboratory investigations including ESR, complete blood count
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random blood glucose , serum creatinine ,CSF analysis , culture and estimation of Il-6 with ELIZA method and high sensitive C-reactive protein with Immunoturbidometry method in serum and cerebrospinal fluid.
Statistical analysis revealed that:
There was no statistically significant difference between studied groups as regarding age and sex.
There was a high statistically significant decrease in the duration of symptoms before admission and significant increase in the duration of hospitalization among patients with bacterial in comparison to aseptic meningitis.
All patients symptomatised with fever, there was no statistically significant difference in vomiting, convulsions, irritability, headache, refusal of feeding, photophobia, altered consciousness , neck rigidity and altered mentality among patients with bacterial and aseptic meningitis and statistically significant increase in the presence of skin rash and signs of meningeal irritation in patients with bacterial in comparison to aseptic meningitis .
There was a high statistically significant increase in serum WBC count in patients with bacterial meninigitis in comparison to other two groups and no significant difference in Hb concentration and platelet count among patients of the studied groups.
There was a highly significant increase in ESR average in patients with bacterial in comparison to aseptic meningitis and control group and no statistically significant difference in ESR average among aseptic meningitis and control group and no statistically significant difference in serum creatinine in patients with bacterial and aseptic meningitis.
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There was no statistically significant difference in blood glucose level and serum creatinine among the studied groups
There was a highly significant increase in turbidity of CSF in bacterial in comparison to aseptic meningitis and control group and significant increase in CSF tension in the majority of patients with bacterial and aseptic meningitis in comparison to control group.
The results of gram stain revealed presence of organisms in 12 patients (63.2 %) and no organisms in 7 patients (36.8 %) of bacterial meningitis patients. While no organisms could be detected in patients of aseptic meningitis. More over the detected organisms in bacterial meningitis patients were gram +ve in 7 patients (36.8%) and gram –ve organisms in 5 patients (26.3 %).
There was a positive CSF-culture in (63.2%) of bacterial meningitis patients and commonly detected organisms were St. pneumonia, N. meningitides and H. influenzae .
There was a highly significant increase in CSF WBCs count CSF polymorphs % and protein and a significant decrease in CSF glucose in patients with bacterial meningitis in comparison to aseptic meningitis and control group.
There was a no statistically significant difference in outcome among bacterial and aseptic cases with recovery with no complications in 14 patients with bacterial (73.7 %) and in 15 patients with aseptic meningitis (78.9 %) ,death in 2 patients with bacterial (10.5%) and in 3 patients with aseptic meningitis (15.8 %) .
There was a highly significant increase in CSF IL-6 level in patients with bacterial in comparison to aseptic meningitis and
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control group with a sensitivity (97%), specificity (96 %), PPV (95 %), NPV(80 %) and accuracy (92 %) in differentiation between cases of meningitis.
There was a highly significant increase in serum IL-6 level in patients with bacterial in comparison to aseptic meningitis and control group with a sensitivity (97%), specificity (90%), PPV (90%), NPV (86%) and accuracy (90%) in differentiation between bacterial and aseptic meningitis.
There was a statistically significant increase in CSF CRP level in patients with bacterial meningitis in comparison to control group and no statistically significant difference in CSF CRP level among patients with bacterial and aseptic meningitis with a sensitivity (53 %), specificity (80%), PPV (91%), NPV(31%) and accuracy (58%) in differentiation between cases of meningitis.
There was a highly significant increase in serum CRP level in patients with bacterial meningitis in comparison to control group and no statistically significant difference in CSF CRP level among patients with bacterial and aseptic meningitis with a sensitivity (97%), specificity (90%), PPV (88%), NPV (83%) and accuracy (88%) in differentiation between cases of meningitis .
There was a positive correlation coefficient between IL 6 level in CSF and serum among the studied groups, a positive correlation between CRP level in CSF and serum among the studied groups and a positive correlation between CRP level in serum and IL 6 level in CSF among the studied groups .