الفهرس 
??Chapter 1: Etiology, epidemiology and pathophysiology of meningitisOnly 14 pages are availabe for public view
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Abstract
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges.
Meningitis can be life-threatening because of the inflammation’s proximity to the brain and spinal cord; therefore the condition is classified as a medical emergency.
Distinguishing bacterial and aseptic meningitis in the emergency department could help to limit unnecessary antibiotic use and hospital admissions. Because the consequences of delayed diagnosis of bacterial meningitis can be severe, any proposed diagnostic tool must achieve near 100% sensitivity.
The aim of the present study was to test the reliability of CSF-TNFα in diagnosis and early differentiation between bacterial and aseptic meningitis. For this purpose, 50 patients were selected from emergency department (ED) of Embaba fever hospital with clinical presentations of suspected acute meningitis, and CSF analysis suggestive of meningitis from January 2014 to June 2014.
They were classified according to CSF examination into 2 groups:
Group (1): 40 patients with acute bacterial meningitis (28 males and 12 females).(culture proven).
Group (2): 10 patients with aseptic meningitis (8 males and 2 females).(culture negative).
All patients were subjected to the following:
1- Clinical study: including full medical history and complete clinical examination for all systems including nervous system with special stress on symptoms and signs of acute bacterial and viral meningitis and history of antibiotic treatment.
2- Routine Laboratory study: CBC, ESR, CRP, ALT, AST, serum creatinine, blood urea and random blood glucose.
3- LP and CSF examination including:
[a] Aspect, color and tension of CSF.
[b] CSF total and differential leucocyte count.
[c] CSF protein and glucose level.
[d] CSF/serum glucose ratio.
[e] Bacteriological examination: Gram’s stain, Ziehl- Neelsen (Z.N) stain and CSF culture.
4- Measurement of CSF- TNFα: by ELISA technique for all patients.
5- Serum TNF-α: by ELISA technique for all patients.
from the statistical analysis of the present study, we can summarize the following results:
Fever was a universal finding in all patients of meningitis. Differentiation between septic and aseptic meningitis on clinical bases was difficult; as there was no statistically significant difference in all signs and symptoms except for convulsions which were significantly higher in group 1.
The bacterial meningitis group characterized by increased CSF WBCs, polymorph predominance, highly elevated CSF protein, reduced CSF glucose and CSF/serum glucose ratio ≤ 0.4 which present in 85% of cases, while the aseptic group characterized by mononuclear cell pleocytosis with nearly normal CSF glucose, normal CSF protein and CSF/serum glucose ratio > 0.4 which present in 62.5% of cases; as there was a high statistically significant difference in WBCs, polymorph %, lymphocytes %, CSF protein, CSF glucose and CSF/serum glucose ratio between the patients groups.
There was a high statistically significant difference in CRP, ESR, platelets count, serum TLC and polymorphs between both patients groups with higher values in group 1 (bacterial meningitis). While, there was no significant difference between the 2 groups regarding Hb concentration.
In septic meningitis group, the detected bacteria were S. pneumoniae in 55%, H.influenza in 30%, Staph.aureus in 7.5% , Klebsiella in 5% and N.meningitides in 2.5% of patients.
Patients with bacterial meningitis (group 1) had a higher value of CSF-TNFα than those of the aseptic group with high statistically significant difference between them, the best cut-off value of CSF-TNFα for early diagnosis of bacterial meningitis was more than 275 and less than 700 ng/ml,with sensitivity of 100% and specificity of 100%.
We noted that in patients with bacterial meningitis (group 1) there was a significant correlation between CSF-TNFα and CSF WBCs (P<0.05) and a highly significant correlation between CSF-TNFα and ESR (P<0.01), While, there was no correlation between CSF-TNFα and other parameters as CRP, CSF glucose, CSF protein, ..etc.