الفهرس 
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Abstract
Bacterial meningitis remains an important and serious infection among children and adults. It is associated with significant morbidity and mortality despite the availability of effective antimicrobial therapy. As bacterial meningitis is a life-threatening and CNS-damaging infection, so rapid and accurate diagnosis is therefore of fundamental importance for effective treatment. Culture and direct microscopic examination of CSF form the basis for routine etiological diagnosis. However, microscopy lacks specificity and requires a high concentration of bacteria in CSF (~ ] 051ml) for a positive result, and culture is time-consuming and falsenegative results are sometimes due to prior antibiotic treatment, thus rapid and non-convential methods, such as latex agglutination test and PCR have been developed. Tlte presellt work aimed to: 1- Isolate and identify the various bacterial agents causing meningitis in Alexandria and to study their antimicrobial susceptibility pattern. 2- Study the diagnostic value of the PCR and Glutaraldehyde test in the diagnosis of tuberculous meningitis. 3- Evaluate rapid methods versus conventional methods for the diagnosis of bacterial meningitis. 4- Study the meningococcal carrier status among the close contacts of cases and its relation to the occurrence of disease. The study was carried out on all patients, who had clinical manifestations suggestive of meningitis, admitted to Alexandria Fever Hospital during the period from September 1997 to August 1998. Their ages ranged from 1 month to 64 years old. A questionnaire sheet was completed for every patient. CSF and blood samples were collected from all patients. Nasopharyngeal swabs were collected from all contacts of N.meningitidis cases. a A. Case study The CSF sample was divided equally into 3 portions and the blood samples were subjected to glutaraldehyde test. . CSF sample The first CSF sample was examined for macroscopic appearance and subjected to centrifugation at’ 2500 rpm for 15 minutes, the supematant was decanted and about 0.5 ml was left behind to suspend the sediment. The sediment was subjected to: 1. Direct microscopic examination by methylene blue, Gram stain and Ziehl-Neelsen stain. ]. Bacterial culture on: . (a) Blood agar and chocolate agar plates incubated at 37°C for 72 h(mI~ ill 5-1GO(\) COl. (b) MacConkey agar, incubated at 37°C for 72 hours. (c) Three slopes of L6wenstein Jensen medium (two slopes at 37°C and one at 25°C) for 8 weeks and checked weekly for evidence of growth. U’ 11 CJummury 01.. LUru;ul.,;)WU Identification procedures based on microscopic examination, cultural biochemical and serological tests (slide-agglutination) were Antibiotic susceptibility test was performed according to Bauer irby method. The second CSF portion was subjected to latex agglutination -est and the third portion was stored at -20°C for nucleic acid detection by CR (Kox et aI1994). Carrier study Nasopharyngeal swabs were streaked on Thayer-Martin agar plates, incubated at 37°C for 72 hours. Isolates were identified biochemical1y and serologically. Bacterial meningitis cases were definitely diagnosed by one or more of he following methods: i- Isolation of bacterial agents from CSF cultures. ii. Detection of bacterial antigen by latex agglutination test. liii. Positive PCR result in TBM cases. IT he results of this study showed that: }. Out of the 121 examined cases, 66.2 were definitely diagnosed as bacterial meningitis.