Background: Meningitis is a public health concern, with several responsible etiologic agents that vary by age group and geographical area. The clinical features and Cerebrospinal Fluid (CSF) examination should determine a presumptive cause of acute meningitis within few hours. This study aimed to highlight the etiological and prognostic factors of acute meningitis in hospitalized febrile patients in Mansoura Fever Hospital, Egypt.
Patients and methods: This study includes all cases admitted with suspected meningitis. The study is conducted in the period between April 2019 and March 2020. Lumbar puncture, CSF examination and blood culture & sensitivity were done. Brain Magnetic Resonance Imaging (MRI) was performed before lumbar puncture in some patients. Detailed analysis of epidemiologic characteristics, clinical data, laboratory findings, the causative organisms and prognosis of all patients with Bacterial Meningitis BM were studied.
Results: This study included 110 patients had Bacterial Meningitis (BM) with CSF leukocytosis > 100 cells/mm3. Out of 110 CSF samples, 95 cases (86.4 %) the pathogens were detected by direct Gram-stained smear. Gram positive cocci were the commonest microorganism isolated. 66.4% of patients had blood culture growth of the same organism as the CSF culture. Reagent strip CSF examinations showed a positive correlation compared with laboratory tests. BM had 22.7 % mortality rate.Predictive factors of oor outocomes include CSF/serum glucose ratio >0.6, CSF protein >80 mg/dl and Tonsillitis respectively.
Conclusions: Patients with suspected meningitis must be referred for lumbar puncture and CSF examination. Prognostic factors that are associated with poor outcome include old age, late presentation, delayed antibiotics treatment, neurologic complications and Glasgo Coma Scale (GCS). BM remains a leading cause of the morbidity and mortality. Early diagnosis and treatment may decrease morbidity and mortality of BM. Predictors of poor outcome of BM are CSF/serum glucose ratio >0.6, CSF protein >80 mg/dl and Tonsillitis respectively.
Keywords: Bacterial meningitis, Lumbar Puncture, CSF analysis