الفهرس 
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Abstract
Aim of the study:
The aim of the present study is to study the role of serum PCT levels in the early diagnosis of bacterial meningitis and to study their efficacy in the differential diagnosis of viral and bacterial meningitis.
Patients and methods:
A total of 60patients finally diagnosed as meningitis were selected from inpatients of Menouf fever hospital, Menoufiya Governorate in the period from April, 2014 to April, 2015. Patients and control subjects were classified into the following groups according to aetiology of disease. Group I: comprised of thirty patients with septic meningitis Group II: comprised of thirty patients with aseptic meningitis. Group III (Control group): comprised twenty 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 procalcitonin .
Summary
601
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.
Signs of meningeal irritation, rash, convulsion and confusion were present in various proportions of patients with astatistical significant differences among the studied groups as regard signs of meningeal irritation.
Highly significant rise of ESR, serum CRP and total leukocyte count in patients with septic meningitis.
CSF turbidity was highly significant in group I patients when compared to group II .
Gram stain revealed the presence of organims in 24 cases (80%) of group I patients and absence of organisms in all of group II, group III.
Positive CSF-culture present in (76.67%) of group I patients and commonly detected organisms were St. pneumoniae (gram positive cocci) in 11 patients (38.33%), N. meningitidis (gram negative diplococci) in 7 patients (30.4%), H. influenzae (gram negative pleomorphic rods) in 3 patients (13.04%).Staph. aureus and E. coli were the least common organisms with the incidence of(4.33%)for both.
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 group II.
Summary
601
Statistical analysis revealed highly significant increase in the mean value of serum procalcitonin level in group I when compared to other groups but in group II when compared to group III,we found no statistical significant differences .
Cutoff PCT level >7.5 pg/dL clearly distinguished patients with meningitis from control group (all patients with bacterial and viral meningitis had a serum PCT level above this level).
Cutoff PCT level >10.36 pg/dL differentiate patients with bacterial meningitis from those with aseptic meningitis with 100% sensitivity and 86.6 % specificity.
All cases that had bad outcome, had higher level of PCT than cured cases.
There was a highly positive correlation between serum CRP level, CSF neutrophils,glucose and protein levels and PCT level.
There was a highly positive correlation between PCT level and blood WBCs and ESR in patients with bacterial meningitis.