الفهرس 
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Abstract
Bacterial meningitis is a major public health problem with a high mortality and risk for permanent sequelae, particularly in children. Accurate and rapid diagnosis and identification of the organism is important in order to start the best treatment available as fast as possible, and to reduce the risk of morbidity and mortality. Culture and direct microscopic examination of CSF form the basis for routine etiological diagnosis. However, microscopy lack specificity and requires a high concentration of bacteria in CSF for a positive result. Culture is time consuming and false negative results are, sometimes, obtained due to prior antibiotic treatment, a situation that has become more prevalent as early treatment has been stressed. Rapid antigen detection methods may provide true-positive results when culture and Gram stain results are negative for meningitis patients who have received antimicrobial therapy. Antigen detection system is independent on recently administered antibiotics. The present study aimed to : 1- Study the efficacy of antigen detection in urine samples against traditional methods for the diagnosis of BM in children. 2- Study the diagnostic value of AO stain, urine test strips and CRP for the preliminary diagnosis of BM. 3- Detection of beta-lactamase activity in CSF. This study was carried out on all children, who had clinical manifestations suggestive of meningitis, and were admitted to the Alexandria Fever Hospital during the period from the beginning of December 1997 to the end of November 1998. Their ages ranged from one day to 18 years. All relevant information was recorded for every patient on admission in a special form. CSF and urine samples were collected from all children in this study. Each CSF sample was divided into two portions. The first portion was subjected to Combur9 strip and C-RP latex test. The other portion was centrifuged, and the sediment was used for direct smear and cultivation. The isolated colonies were examined for their morphological and biochemical characters. Antibiotic susceptibility was determined by Bauer-Kirby method. Beta lactamase activity was detected by oxoid sticks. Urine samples were concentrated by ethanol, acetone precipitation and subjected to latex agglutination test for detection of group B streptococci, H.influenzae b, S.pneumoniae, N.meningitidis ACYW135, and N.meningitidis group B/E.coli K1. Out of 174 cases included in this study, the diagnosis was changed in 64 after re-examination in the hospital to other conditions e.g. measles, bronchitis …….etc. Out of the remaining 110 cases, 42 (38) cases were definitely diagnosed as BM by each or both of the following methods: One- Conventional methods (direct microscopy and / or culture). Two- Antigen detection in urine by latex agglutination. Preliminary diagnosis of the above cases was done by one or more of the following methods: AO stain, CRP, and Combur9 strips.