الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Acute cerebrospinal meningitis remains a major problem in the
developing counteries, unless an early reliable diagnosis and proper
therapy are instituted, Mortality and long term neurological sequelae
may occur.
The aim of this study is to test the reliability of both CSF JL·6 and
IL-8 in early diagnosis of meningitis and in differentiation between its
septic, tuberculous and other aseptic types.
This work was carried out on seventy infants and children
(41males and 29 females) recruited from Benha Fever Hospital during
the period from June. 1997 till May, 1999. Their ages ranged from three
and half months to twelve years. Fifteen cases out of this total number of
cases had proved to be free of meningitis by
CSF examination and were served as a control group for both JL-6 and
IL-8 level and other criteria of diagnosis. The remaining patients were
divided according to the results of CSF examination into another four
groups; a group of septic meningitis with positive CSF bacterial culture
(n= 18). a group of septic meningitis with negative CSF bacterial culture
(n= 21), a group of tuberculous meningitis (n=6) and a group of aseptic
non-tuberculous meningitis (n= 10).
Fever was the major complaint, it was present in 98.2% of cases of
meningitis. Headache was also present in 69.2%. 33.3% and 60% of
patients with septic, tuberculous and aseptic non-tuberculous meingitis,
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_.Summary anti Conclusion
The meningeal irritation signs were present in the form of neck
rigidity in 82.1%,100% and 100%, also Kernig’s and Brudzinski’s signs
in 66.7%, 33.3% and 40% of cases with septic, tuberculous and aseptic
non-tuberculous meningitis respectively. Bulging anterior fontanelle was
present in only five cases in the septic meningitis groups and in two
cases in the tuberculous meningitis group and all cases were below one
year of age.
There was a highly significant increase in CSF white cell count in
patients of the septic meningitis groups with polymorph predominance
and a relatively mild increase in patients of the tuberculous and aseptic
non-tuberculous meningitis groups with lymphocyte predominance.
CSF glucose was found to be significantly reduced in patients of
the septic and tuberculous groups, while CSF protein was highly
elevated in the same patients with a slight elevation in patients of the
aseptic non-tuberculous meningitis group.
In this study, the cerebrospinal fluid IL-6 and IL-8 levels in all
meningitis patients were significantly elevated when compared to that of
controls and a cut-off value between normal and increased CSF IL-6 and
IL~8 levels was determined to diagnose meningitis cases. Their levels
were also high among patients of the septic meningitis groups whether
the CSF bacterial culture was positive or negative and there was no
significant difference in their levels between both groups.
There was no significant difference in CSF IL-6 levels of patients
with tuberculous and aseptic non-tuberculous meningitis, however, CSF
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lL-8 levels were significantly highly elevated in patients with
tuberculous meningitis when compared to other meningitis patients.
Also it was observed in this study that there was no significant
correlat ion between the type of the microorganism causing septic
meningitis and both CSF IL-6 and IL-8 values. however, there was a
clear correlation between both CSF IL-6 and IL-8 levels and CSF
differential white cell count in all meningitis patients.
We conclude that both CSF IL-6 and IL-8levels could be used in
diagnosis or exclusion of meningitis, as CSF IL-6 and IL-8 are highly
sensitive (100%). This means a zero false negative rate results i.e. a good
negative test. Also, CSF IL-6 and IL-S are highly specific (100%). This
means zero false negative rate results i.e. a good positive test.
We also conclude that high levels of CSF IL-6 could be used to
differentiate septic from aseptic meningitis, but could not differentiate
between septic meningitis cases with or without positive bacterial culture
or between aseptic meningitis cases whether tuberculous or 110ntuberculous.
We also conclude that very high levels ofCSF IL-8 could be used
to diagnose tuberculous meningitis cases, while high levels could
”~ differentiate between septic and aseptic non-tuberculous meningitis
cases. Also, CSF IL-8 could not differentiate between septic meningitis
cases with or without positive bacterial culture.
We recommend further longitudinal study for follow up the kinetics of both CSF IL-6 and IL-8 that it may be used as prognostic
tests.