الفهرس 
MENINGITISOnly 14 pages are availabe for public view
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Abstract
A
cute bacterial meningitis is at least ten times more common in developing countries than in the rest of the world and is almost always fatal without treatment. Survival depends on accurate diagnosis and the early administration of antibiotics.
Despite the advances in diagnosis and treatment of infectious diseases, meningitis and encephalitis are still considered to be important causes of mortality and morbidity. In efforts to decrease the morbidity and mortality related to bacterial meningitis, having an early diagnosis and starting immediate empirical therapy are the key factors. The early start of the first dose of antibiotic causes highly decline in neurological complications and decrease the rate of morbidity and mortality.
The aim of the present study was to test the reliability of prognostic factors in acute bacterial meningitis. For this purpose, 50 patients were selected from emergency department (ED) of abbassia fever hospital with clinical presentations of suspected acute meningitis, and CSF analysis suggestive of meningitis from April 2014 to Feb 2015.
All patients were subjected to:
1) Full history taking and clinical examination with stress on presence of headache, fever, neck stiffness and altered mental status and seizures on admission.
2) Laboratory investigation: including complete blood picture, Random blood sugar, liver function tests and renal function tests to exclude other causes of disturbed level of consciousness,
3) Radiological study MRI or CT scan brain was done whenever needed.
4) Sample collection:
5) CSF analysis including:
– CSF was obtained by a sterile Lumbar puncture needle under complete aseptic conditions introduced between L3-L4 or L4-L5 intervertebral space collected in sterile screw capped container.
Cell counts, differential count and cytology
Glucose level, with a simultaneous blood glucose level protein level
Gram stain, appropriate bacteriologic culture and sensitivity
6) Special sheet form to evaluate the different prognostic factors including:
• Age
• Gender
• Residence
• Socio economic state
• Special habits
• Job
• Co morbidities (DM, HTN, Renal or Hepatic diseases)
• Time interval between onset of first symptom and hospital admission
• Time interval between onset of first symptom and start of specific treatment (antibiotic / antiviral)
• Patient with severe neurological impairment on presentation.
• Laboratory results (CBC, liver enzymes, renal functions)
• Failure of primary therapy and shift to other treatment
• Results of culture (CSF and / or Blood)
• Duration of therapy
• Duration of hospital stay
• Occurrence of permanent neurological complications during follow up period
• Occurrence of other complications during follow up period (e.g.chest infection, bed sores…….)
from the statistical analysis of the present study, we can summarize the following results:
Acute bacterial meningitis is more common in males (70% of cases )with low socioeconomic state (76% of cases).
Significant factors that affect prognosis (permenant neurological deficit) were(3); the time between symptoms and admission, random blood sugar as apart of lab results and duration of hospital stay. Neurological complications devided to fine tremors of the hands (5)cases, deafness (4)cases, slurred speech (3)cases and (rt or lt sided) weakness of the body (17)cases.
Mortality rate was affected by failure of primary therapy , neurological impairment on presentation, liver transaminases and platelets count.