C- - إشراف أ.د علي إبراهيم أستاذ في قسم الا طفال د. فيصل مروشية مدرس في قسم الا طفال إعداد طالب الدراسات العليا إیاد درغام الدو
: :. وعلى ال رغم م ن أن معظ م. :[1,2] (1.1) : : : : : [1](c.s.f) (1.2) (choroids plexus) 25% (c.s.f). ١
(c.s.f).(c.s.f).(c.s.f ) (c.s.f) (c.s.f) (pressure gradient) (c.s.f). (Monro) (c.s.f) (Sylvius) (Luschka) (c.s.f) (Magendie. (Epidemiology) : (1.3) :[1] - : ( ).. (-). :. (properdin) (C5-C8).b.... (/,) ) % % ( /. % ٢
. (% %) C B ( ) %. (-) %. (/) (/) % ( ). % ( - ) b :[4] - % (-) (/ ) % ) ( ).( ) :.(... ٣
: [3] - B5.(11-6-9-4) % 9 HSV1-HSV2 % HSV1 % HSV2. (pathophysiology) (1.4) :[1] -. b.. IgG IgM. (C.S.F) ٤
( ) ( ) (P.G.E) (IL1)1 (T.N.F)... ( ) (C.S.F) (SIADH). (C.S.F). (C.S.F) ( ).( ) ٥
: [2,3] - ( ) (H.S.V1).. (1.5) :[1] - : -.( B E.COLI).. IgG ٦
(-) IgG.. : - %( -) CO2 %(-) - MULLER-HINTON. (W135YCBA) IgA (endocytosis) ) (. (-) : b - ( )v ( )x. A. b F ٧
b. :[3] - DNA (HSV): -. HSV. % HSV2HSV1 1 (ELISA) DNA %. Π % : - (picorna viridae) RNA ( ). PH ) (. (11-9-4-6) B5 ٨
(1.6) :[1] -.. : : - (DIC). : -... : (%-)- ( ) -.( ) -.( ) - : -. (Kernig) - (Brodzineski) -.. : - - - - - ( Stupor) ( Decorticate ) ( Decerebrate).. ٩
%- %. ( ) %-.. : / %. : ( ( ( ( ( ( ( ( : ١٠
(1.6.1 ) ) (- ١١
(1.6.2) ) ( ) ( ) ( - %- ) (, ( ) ( ) :[3] - ( ). (Hyperesthesia). ١٢
: (1.7) :[3] ( ) DIC (SIADH) CRP ( ). DIC PT. MRI : :[1] - () () (CSF). :[5] ١٣
(1.7.1).. : : - (csf) : - -. : - (CSF ) ( ) / ١٤
(csf) - / -. /, ) (.( ) / ( CSF) / - (%-) %./ : - > ).( / (CSF) % CSF (, ). (CSF) (CSF) : - - - : - % (/, -, ). : - ١٥
( ) (particle) (Antigenuria). b.(csf) : - %(-). : ( - ) ).( ١٦
C_ (1.8) C-Reactive Protein (C.R.p) : FrancesTillet C (C.R.P). (Pentaraxin) :[6,5] (C.R.P) - (C.R.P) (P.D.F) (MACROPHAGE). : (1.8,1) - - - - - - C1s-C2-C3-C4-C5 - - - - - - - C - A - - ١٧
" (C.R.P) -. (IL1-IL6-T.N.F) (C.R.P) (C.R.P) (C.R.P) (C.R.P) (-) (C.R.P) : ( / ) ( C.R.P ) ) - (... - -. - : - - - - ( ) - ( ) - ( ) - ( ) - ( ) - : / (-) (C.R.P) - - - - - - ١٨
: (C.R.P) - (C.R.P) :[7] -. (C.R.P) / () (-) (C.R.P). / : [7] - ) (C.R.P) (C.R.P) (... (C.R.P). :[8] - (C.R.P) (C.R.P). (C.R.P) % (-). (C.R.P) % (C.R.P) % % % :[8] % - - - - - - ١٩
. : (C.R.P) - (C.R.P) (C.R.P) (C.S.F) (C.R.P).[9] C.R.P % (C.S.F). (C.R.P) Rajs. (NO).[10] (C.R.P) (C.R.P) (C.R.P). (C.R.P) : (1.9). ٢٠
:[1] - b %(-) %( -). %(-). ( / // ) ( / // ).( / // ) ( / //). ( -) :- :.( -) :-. ( ). : - :[1] - (CSF). b ( /,).( -) ٢١
) :[1,3] - ( : ).(. (/,-,) ( /,) (/ -) ( //).( / -) : : - (ADH) -.(SIADH) % : -. ).( - ٢٢
% : -.. -. -. - ٢٣
: : : C C CRP. (2.1) :. : CRP :. CRP :. CRP :. (2.2) :. : - ٢٤
. : - (2.3) :. CRP : CRP :. CRP. CRP. (C.R.P) / (C.R.P) /.[11] (piosystem) :[1] % (-) %(-) % (-) :[4,1] % (-) %(-) :[1] / (-) / (-) / (-) /(-) ٢٥
: : : (2.4) ( -) () ( ) : (:) 8 7 6 5 4 3 2 1 0 الذآور الا ناث (2.4.1 ) (% ) (% ) (2.4.1 ) ( % ) (% ) (% ) (% ) (% ) (%) (%).. (%) () ٢٦
( % ) : (%) (%) 50% 40% 30% 20% الجراثيم سلبية الغرام العقدیات لم یكشف العامل 10% 0% (2.4.2) () : : 14000 12000 10000 8000 6000 4000 2000 0 تعداد الكریات البيض عدد العدلات عدد الحالات عدد الكریات (2.4.3) (%) (CRP).( / - ) (%) (%) ( ) (% ) ( ) : ٢٧
700 600 500 400 300 200 100 0 تعداد الكریات البيض آثيرات النوى (C.S.F) (2.4.4) (%, ) ( ).( -) (%, ) ()./ (-) (%) () (C.S.F-CRP).(%, ) () : (%) (%)./ (-) (CRP) (%) () () (%,) ().(%) ().(%, ) () ( C.S.F-CRP) (%) (CRP). (% ) (C.S.F-CRP) (CRP) :. ٢٨
700 600 500 400 300 200 100 0-100 0 2 4 6 8 10 12 14 الكریات البيض C.S.F-CRP (C.S.F-CRP) (2.4.5) (CRP) : (R=75%) 30 25 20 15 10 5 0 0 2 4 6 8 10 12 14 (CRP) (2.4.6) البروتين CRP عدد الحالات بروتين CSF غ/ ١٠٠ مل قيمة CSF CRP ملغ/ ١٠٠ مل : () (%) () (CRP ) (%) (%) (C.S.F-CRP) : (C.S.F.-CRP) ٢٩
30 25 20 15 10 العيار الا ول العيار الثاني 5 0 (C.S.F-CRP) (2.4.7) () (C.S.F-CRP). ٣٠
: (2.5) (%) ( ) (:,) (,) ( -,) (%) (%) (%) (:).(:,) (%,) : (%) (%) (2.5.1) (%) (%) (%) (%) (%) ( ) ) ( ) (.( ) : () ( ) () () ( ) ( ) ( ) (% ) (CRP).( ) (CRP).( ) (%) ٣١
.( ) ().( ).( ) (C.S.F-CRP) ( ).( ) (CRP) : ( ).( ) (C.S.F-CRP) ( ) CRP-CSF ملغ/ ١٠٠ مل 60 50 40 30 20 10 0 C.S.F- CRP1 C.S.F-CRP2 عدد الحالات (C.S.F-CRP ) (2.5.1) (CRP) : ٣٢
(CRP) (2.5.2) CRP (%) (% ) (% ) (% ) CRP (% ) (%) (CRP) (%) (% ) (% ) (CRP) (%).(% ) (% ) (R=71%) (CRP) 120 100 80 60 40 20 0 تعداد الكریات البيض تعداد الكريات البيض/مل CRP-CSF ملغ/ ١٠٠ C.S.F-CRP عدد الحالات C.R.P (2.5.2) (CRP) : ٣٣
(2.5.3) CRP CRP (2.5.4),, CRP,, CRP (CRP) (X²=10.9). (P= 0.01) (X²=1.39) (CRP). (CRP) (C.S.F-CRP) (C.S.F-CRP) (R=70%) : 140 120 100 80 60 40 20 0 البروتين بروتين CSFملغ % CSF-CRP ملغ/ ١٠٠ C.S.F-CRP عدد الحالات (C.S.F-CRP) (2.5.3) ٣٤
: (2.5.5) (%,) (%) (%,) (%) (P1=75%,P2=33.3%) (Z=1.8). (%). (C.S.F-CRP) : (2,6) () () () (,) ( ) : (2.6.1) (%) (%) (%) (%) (%) (%) ٣٥
: () ) ( ) (E.COLI).( : ) () ( ).(.( ) () (CRP) ( ) ( ).( ) (C.S.F-CRP) (CRP) ( ) (CRP) ( ) (). ( ). 500 مل / 400 300 200 100 0 البزل الا ول البزل الثاني تعداد الكریات في CSF عدد الحالات. (2.6.1 ) ٣٦
( ) ( ) () ( ). () (C.S.F-CRP) (C.S.F-CRP). % % (CRP).(%) % % (C.S.F-CRP).% (CRP) : ( ) (2.6.2 ) CRP CRP (X²=0 ). (CRP) : (C.S.F-CRP) (2.6.3) (C.S.F-CRP) (C.S.F-CRP) ٣٧
(C.S.F-CRP) (P=0.01) (X²= 10). (R=44%) (C.S.F-CRP) : 700 600 500 400 300 200 100 0 تعداد الكریات البيض تعداد الكریات البيض /مل CSF-CRP ملغ % قيمة (C.S.F-CRP) عدد الحالات (CRP) (2.6.2) (C.S.F-CRP) : (R=90%) 120 CSF-CRP ملغ% بروتين CSF ملغ % 100 80 60 40 20 0 البروتين (C.S.F-CRP) عدد الحالات (CRP) (2.6.3) ().. ٣٨
:(2.7) () (%,) () (CRP) ).( CRP ) ( : (CRP) : - (CRP) ( % % ) (C.S.F-CRP) (C.S.F-CRP) (C.S.F-CRP).(C.S.F-CRP) (C.S.F-CRP) (CRP) (CRP) (C.S.F-CRP).( ) : - (%) (% ) (CRP) (C.S.F-CRP) ( % % ) (CRP ) (C.S.F-CRP) (CRP) (C.S.F-CRP) (C.S.F-CRP) ( %%). (C.S.F-CRP). % ) : - (CRP) (C.S.F-CRP) ( % (CRP) % % (C.S.F-CRP) % % (CRP). ٣٩
: (BRIGNIER PARSAD) : [11] ( () () () () (CRP) () (CRP) (CRP) (%) (%) (C.S.F-CRP).(%) (%) :[12] ( (KAMALARAJA) (VENKATA.S, AJAY GAUR) % ) ( ) % % (C.S.F-CRP) ( % (CRP) %.% % (CRP) (C.S.F-CRP) (C.S.F-CRP). (C.S.F-CRP). ٤٠
:(2.8) (CRP) (CRP) -. (CRP) (CRP) -. (CRP) (CRP) -. (CRP) -. (CRP) -. -. : (2.9) (C.R.P) -. (C.R.P) -. -. -. ٤١
الملخص (-) :. < < : -. < : - :. (CRP) C : -. CRP : - : CRP ( ) : - % CRP CRP. % ( ) : - ( % ) CRP % CRP % % % %. % % ( ) : - CRP (%) % % % %. % % % % ٤٢
ABSTRACT The study included 42 patients admitted to pediatrics department in AL-ASSAD university hospital in the year (2003-2004), with diagnosis of meningitis by lumbar puncture which was considered positive according to the following values : 1- newborn : > 20 lymphocyte or > 10 polymorphinuclear cells. 2- infants and children : > 5 lymphocytes or polymorphinuclear cells. the following laboratory parameters were performed to all patients: - Blood: complete blood count, sugar, CRP. - Cerebrospinal fluid ( C.S.F): white blood cell count, sugar, protein, CRP, and culture. We divided the patients into the following groups : 1- Newborn group : this group included 12 patients ( 8, 4 ), and C.S.F CRP was positive in only 7 patients, with sensitivity of 58 % and there was on relationship between WBC in C.S.F and the value of CRP in C.S.F, serum CRP was positive in all patients with sensitivity of 100 %. 2- Children with age less than 2 years: it included 20 patients (12,8 ), bacterial meningitis was diagnosed in 8 patients (40%) and viral meningitis in 12 patients, sensitivity of C.S.F CRP and serum CRP was 100 %, specifity of C.S.F CRP and serum CRP was 75 %, 25 % respectively, and positive predictive value was 73 %, 50 % respectively, negative predictive value was 100%, 75 % respectively. 3- Children with age more than 2 years: included 10 patients (7, 3 ) bacterial meningitis was diagnosed in 5 patients(50 %), sensitivity of C.S.F CRP and serum CRP was 100%, 80 % respectively, and specifity was 100%, 50 % respectively, positive predictive value was 100%, 50 % respectively, negative predictive value was 100%, 50 % respectively. ٤٣
(REFERENCES) 1- BERHMAN,R. KLEIGMAN,R. JENSON,H,2000 NELSON TEXTBOOK OF PEDIATRICS, 16 TH EDITION, W.B.SAUNDERS COMPANY, U.S.A, PP 751-760. 2- SNELL. CLINICAL ANATOMY, 3 RD EDITION, PP 90-95. 3- HAY,W. HAYWARD,A. LEVIN, M. SONDHEIMER,J, 2001 CURRENT PEDIATRICS DIAGNOSIS & TREAMENT, 15 TH EDITION, LANGE MEDICAL BOOKS/Mc GRAW-HILL, U.S.A, PP 768-772 4- T-GOMELLA-D. CUNNINGHA. NEONATOLOGY: MANAGEMENT, PROCEDURES, USUAL PROBLEMES, DISEASES AND DRUGS. 4 TH EDITION 1999 PP 410-414. 5- NSW HEATH, MANAGEMENT. OF ACUTE BACTERIAL MENINGITIS IN INFANTS AND CHILDREN. PP 64-70 6- BERMAN,S. 2003 PEDIATRIC DECISION MAKIING, 4 TH EDITION, MOSBY, U.S.A. PP 85-95 7- Pepes, MB. The acute phase response and c-reactive protein. The oxford textbook of medicin 1996 Ed. 3, vol2. PP 1527-1533. 8- YONG, B. BLESON, M. c-reactive protein: Acritical review, pathology 1996 PP 118-124. 9- YASOJIMA, K. SCHWAB, C. McGEER. HUMAN NEURONS GENERAT c-reactive protein AND AMYLOID P. BRAIN RES 2000 PP80-90. 10- HELSINKI UNIVERSITY, CENTRAL HOSPITAL FOR CHILDREN, HELSINKI FINLAND. FILE "A:\enterspubMed.htm". 11- BARSAD, C. NEIRS, B. CHILDHOOD BACTERIAL MENINGITIS AND USEFULNESS OF CRP, MJAFI. VOL 61, NO1, 2005, PP13-15. 12- VENKATA, S. GAUR, A. CERBROSPINAL FLUID CRP ESTIMATION FOR BEDSIDE DIANOSIS OF PYOGENIC MENINGITIS, INDIAN PEDIATRICS, VOL 41, OCTOBER 17 TH -2004 PP 1073-1076. ٤٤
. : (1.1) (1.2) (1.3) (1.4) (1.5) (1.6) (1.7) C_ (1.8) (1.9) : (2.1) (2.3) (2.7) (2.8) (2.9) ٤٥