الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Pediatric meningitis is a medical emergency which requires a high index of clinical suspicion, prompt diagnosis, and early and aggressive protocolized management. New vaccination programs have led to a change in epidemiology of the disease; however, it remains prevalent worldwide. Advances in clinical and investigation techniques are aiding the diagnosis of bacterial meningitis, and a combination of techniques is useful to confirm or exclude the diagnosis. While antibiotics, steroids, and supportive therapy remain the mainstay of treatment, further research should be performed into the roles of adjuvant therapy.
The conducted study is retrospective study.360 patients records were included in the study their age ranged between 1month and 15 years. The study was done at Alexandria fever hospital. The data included age, sex, residence, seasonal variation, clinical picture, laboratory investigations treatment received, response to treatment, children were divided into 4 groups according to their age one month to one year Preschool age; from one year to 5 years; from 5 years to 10 years and from 10 to 15 year. Data were collected from patient files after Approval from ministry of health and the directory of the hospital was obtained.
Collected data are:
a) Epidemiological data: age, gender, place of residence, occupation of the mother, onset date, admission date and prior antibiotic treatment.
b) Clinical data: presence of the following manifestations on admission (fever, seizures, nausea/vomiting, headache, skin rash or lesion , stiff neck, bulging fontanel in infants less than one year old).
Around seventy eight percent of children were referred from Alexandria University Children Hospital, 17.5 came from home and 4.8% from private clinics. All children that were referred from Alexandria University Children Hospital, were referred with CBC, renal functions, liver functions, electrolytes and CSF analysis without culture. All children received empirical treatment. Follow up CSF analysis and culture was done for all cases after one week to ten days.
Fifty percent came below 1 year. Males (61.9%) were more than females. more children from rural areas than urban areas. The cases were distributed more in summer and spring.
As regard symptoms: fever was present in all children followed by vomiting 63% convulsion 45% refusal of feeding 24% and irritability 12.5. Headache 15%, photophobia 8.3% and hallucination 3.6%.
Signs: fever present in 100%of cases, toxic look in 57%.,disturbed sensorium in 36,6%,neck rigidity in 24.4%,bulging fontanel in 28% positive kering sign in 11%, positive Brudiznski sign in 9.4%,squint in 3.3%, rash in 8.3% and shock in (.5%)
As regard CSF analysis, CSF protein level was elevated in 38.8%) % of cases, 27.7% of samples was not done due to low level of assay and the glucose was considered low in 36.6%. All cases showed increase neutrophils in their CSF. In the results of CSF cultures in the present study, most of cases (86%) showed negative cultures, 7% had streptococcus, 3.5% had Haemophilus influenza and 3% had Neisseria meningitides in. Leukocytosis in CBC was present in 58.6% of cases, anemia in 46.6% of cases, thrombocytosis in 38% of cases while thrombocytopenia in 1.3% of cases.
About complications during hospital stay the most common complications during hospital stay in the present study were seizures 6.9%, Hydrocephalus 3%, Hearing loss 2.2%, squint 2.2%, subdural effusion 1.3%, shock 1.1%, skin rash.8% electrolytes disturbances. 5% and brain abscess 0.5%
There is no statistically significant relation between out come of studied cases and results of CSF culture. There is a statistically significant relation between seizure and occurrence of complications. There is significant relation between high neutrophil count and low glucose level and the occurrence of complications. There is no relation between high protein level and presence of organisms and occurrence of complications.