Diagnosis of Bacterial Meningitis from Meningitis Suspected Patients Attending Tribhuvan University Teaching Hospital (TUTH)

Abstract

Meningitis, an acute medical emergency, is one of the leading causes of mortality, morbidity and neurological sequel in developing countries like Nepal. With the view to elucidate characteristics of Cerebrospinal Fluid in meningitis suspected patient, present work was carried out in Tribhuvan University Teaching Hospital (TUTH) within period of five months (16 the September, 2009 to 16vi the February, 2010). A total of 183 CSF samples received, 162 samples suspected of meningitis were processed in the laboratory. The macroscopic observation was made. Microscopic observation (viz. Gram staining) and microbiological study was done after centrifugation of CSF at 3000 rpm/10min. Antibiotic Susceptibility was determined. A set of CSF variables referred as routine parameters (i.e. detecting protein, Glucose and cellular changes) were analyzed. Altogether 11 (6.7%) bacterial isolates were recovered; 6 (54.5%) were Gram negative and 5 (45.5%) were Gram positive. From 10 (90.9%) CSF samples, bacterial isolates were identified and Antibiotic Susceptibility pattern was recorded. Male and female were found not to differ significantly with cases of meningitis (P<0.05; M:F::1.75:1). The association of the higher count of leukocyte with the cases of meningitis was found to be statistically significant (P<0.05). Of 11 cases of meningitis Streptococcus pneumoniae (27.4%), 18.2% Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and a Pseudomonas aerugonisa (9%) were isolated and identified and 1 Gram negative diplococci was seen only by Gram staining of fresh CSF sample. Specificity and PPV of glucose test for suspected cases of Bacterial Meningitis were 88.07% and 37.93%, and of protein test were 84.10% and 31.42%. Specificity and PPV of determined CSF/serum glucose ratio in suspected cases of meningitis were higher, 96.68% and 69.43% respectively as compared to CSF glucose and protein test only. Antibiotic Susceptibility pattern of the isolates showed that most of the isolates were susceptible to Chloramphenicol (70%). Key words: Meningitis, CSF (Cerebrospinal fluid), cell count, Gram Stain.