الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 102 |  |  |
| | | from | 102 | | |
Abstract
It is important to distinguish bacterial meningitis from non bacterial meningitis during the acute phase of the disease as the clinical symptoms are often similar. This could help to avoid complication and to limit unnecessary antibiotic use and hospital admissions. Repeated CSF analysis should be performed for any patient who has not responded clinically after 48 hours of appropriate antimicrobial therapy.
The aim of the current study was to evaluate the potential diagnostic role of measuring Heparin-binding protein HBP level in cerebro-spinal fluid and serum of Children with meningitis & the availability of using Heparin-binding protein level as an indicator for early diagnosis and differentiation between bacterial and non bacterial meningitis.
For better assessment, this study was carried out on 45 children admitted at fever hospital, Shebien El- Kom, Menoufia, Egypt during the period from july 2019 till july 2020
They were classified retrospectively after sample collection into 3 groups:
group 1: include 15 patients with acute bacterial meningitis.
group 2: include 15 patients with acute non bacterial meningitis.
group 3: include 15 patients with normal CSF findings )as a control group)
All infants and children in studied groups were subjected to:
History details with special emphasis on Fever (Onset, pattern and duration), feeding difficulty, headache, vomiting, photophobia, blurring of vision, alteration of consciousness, convulsions and movement disorders.
History of antibiotic intake prior to admission and history of recent vaccination.
General examination of vital data including: Pulse (Brachial or radial), temperature, blood pressure and respiratory rate, examination of skin for the presence of petechial eruptions or rash.
Neurological examination with special emphasis on level of consciousness, observation of convulsions if present, the examination of fontanelles if opened, signs of meningeal irritation (Nuchal rigidity, positive Kernig and Brudzinski signs), motor system, sensory system, an examination of the cranial nerves, examination of cerebellum and coordination, and other system examination (Chest, CVS, abdomen).
Routine investigations, including Complete blood count with differential white blood cell count and C reactive protein (CRP).
CSF samples were obtained at the time of lumbar puncture under complete aseptic condition 3ml of CSF were collected in 3 sterile tubes. The CSF samples were subjected to the following investigations: Physical examination tension and aspect, chemical examination protein and glucose (mg/dl), cell count: total and differential leukocytic count (cells/ mm³) and bacteriological examination (CSF culture, measurement of serum & CSF HBP by ELIZA technique).
Acute bacterial meningitis usually present with acute onset and nonbacterial meningitis usually present with sub-acute onset. Differentiation between septic and aseptic meningitis on the clinical bases was difficult; as there was no statistically significant difference in vomiting convulsions, headache, altered consciousness, irritability, neck rigidity and signs of meningeal irritation between the two patient groups.
The bacterial group characterized by increased CSF WBCs, polymorph predominance, highly elevated CSF protein, reduced CSF glucose in most patients, while the aseptic group characterized by mononuclear cell pleocytosis with nearly normal CSF glucose and normal or slightly elevated CSF protein.
Heparin-binding protein (HBP), also known as Azurocidin and Cationic Antimicrobial Protein (CAP37), is a positively charged 37 kD glycoprotein released from the secretory vesicles and azurophilic granules of activated neutrophils in severe sepsis. Structurally, it belongs to a hematopoietic serine protease superfamily with antimicrobial function. It forms a part of the innate defenses of human neutrophils. HBP is easily and rapidly mobilized from migrating neutrophile.