الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Summary
It is important to distinguish bacterial meningitis from aseptic 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 CSF IL-8 level in differentiation between septic & aseptic meningitis.
For better assessment, this study was carried out on 90 patients admitted at Abbasia fever hospital.
They were classified retrospectively after CSF study into 3 groups:
Group 1: 49 patients with bacterial meningitis.
Group 2: 30 patients with aseptic meningitis.
Group 3: 11 patients with TB meningitis.
All patients were subjected to clinical study including full medical history and complete clinical examination for all systems including nervous system with special stress on symptoms and signs of acute bacterial and viral meningitis, routine laboratory study including CBC, CRP and random blood glucose, lumbar puncture and CSF examination including:
[a] Aspect, color and tension of CSF.
[b] CSF total and differential leucocytic count.
[c] CSF protein and glucose level.
[d] Bacteriological examination: Gram’s stain, Z.N stain and CSF culture, measurement of CSF IL-8 by ELIZA technique.
Differentiation between septic, aseptic and TB meningitis on 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 patients 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.
In bacterial meningitis patients, the detected bacteria were S. pneumonia in 71.4%, N. meningitides in 20.4%, and H. influenzae in. 8.2% of patients.
There was no significant difference regarding to the age, sex and clinical presentation of the studied groups.
The CSF IL-8 values in patients with bacterial and TB meningitis were significantly higher than those with aseptic meningitis.
Regarding the bacterial group there is significant correlation between CSF IL-8 with CSF glucose & CSF WBCs.
Regarding the aspetic group there is significant correlation between CSF IL-8 with CSF WBCs & WBCs.
Regarding tuberculous meningitis there is significant correlation between CSF IL-8 with CSF glucose, CSF WBCs and WBCs.
These results were suggested that IL-8 is important mediator in the meningeal inflammatory process in patients with bacterial meningitis.
At cut off value 121.77 pg/ml the area under ROC curve was 0.774 for the best differentiating viral from non viral meningitis with a sensitivity of 76.7%, specificity of 53.3%, negative predictive value 53.3%, positive predictive value of 76.6% and diagnostic efficacy of 68.9%.
While at cut off value 154.77 pg/ml the area under ROC curve was 0.613 for the best differentiating tuberculous from bacterial meningitis with a sensitivity of 54.5%, specificity of 51%, NPV of 83.3%, PPV of 20% and a diagnostic efficacy of 51.7%.