Objective: Bacterial meningitis is an important and frequent devastating disease. Present study was carried out to know the incidence of pyogenic meningitis in our hospital, to study the bacteriology of acute pyogenic meningitis, antibiogram of the isolates and usefulness of C- reactive protein (CRP) in cerebrospinal fluid in the diagnosis of acute pyogenic meningitis in comparison with culture and to know the sensitivity of Grams staining and culture.

Materials and Method: A total of 165 clinically suspected meningitis patients between the age group of 2 days to 14 years including both sexes admitted to department of pediatrics were included in the study. The CSF sample was collected under aseptic precautions in a sterile container and centrifugation was done. After centrifugation, the supernatant was aliquot to another test tube and used for cell, sugar, protein and CRP tests. The sediment was used for Grams stain, Ziehl-Neelsen staining and culture and sensitivity test. Identification and antibiotic susceptibility test done by the standard Kirby-Bauer disc diffusion method according to CLSI guidelines. The zone of inhibition were measured and interpreted according to CLSI guidelines.  All media and antibiotic disks were supplied from Himedia, Mumbai, India.

Result:  Out of 165 CSF samples studied, 45(27.2%) were diagnosed as pyogenic meningitis. H.influenzae was the commonest organism 10(22.2%), followed by Streptococcus pneumonia 8 (17.7%), Staphylococcus aureus 6(13.3%), Acinetobacter species 2(4.4%), Coagulase Negative Staphylococci 5(11.11%), E. coli 2(4.4%), and one case each of Klebsiella species, Group B streptococci species, Proteus species, Pseudomonas species and Enterococci species. The sensitivity of Grams staining test was 91% and that of CRP test was 64.5%. As most of the cases included in our study were treated earlier, the culture positivity was only 62.2%.

Conclusion: Grams staining, C- reactive protein, culture and sensitivity tests if done properly are most rapid and reliable tests for the diagnosis of pyogenic meningitis.

Keywords: pyogenic meningitis, Grams staining, C - reactive protein.

1. Pyogenic meningitis. Lippincott Williams and Wilkins.
2. Collee JG, Marmion BP, Fraser AG, Simmons A. Makie and Mac Cartney: Practical Medical Microbiology.14^th New York:Churchill Livingstone, 1996.
3. Koneman EW, Allen SD, Janda WM, Schrechkenberger PC, Winn WC. Colour atlas and Text Book of Diagnostic Microbiology. 5th ed. Philadelphia: Lippincott Raven Publishers, 1997.
4. Collin CH, Lyne PM, Grange JM. Microbiological methods. 7th ed. Butterworth- Heinemann Ltd: New Delhi, 1995.
5. Forbes BA, Daniel F, Sahm, Weissfeld AS Bailey and Scott's Diagnostic Microbiology. 11th ed. Mosby: Philadelphia, 1998.
6. Kumar R, Khurana S, Gupta BK. Meningococcal meningitis in Ind J Path Microbiol 1992; 35(4):340-4.
7. Gaitonde S, Joshi VR. C-reactive protein as a guide to the diagnosis of meningitis. The Indian Practitioner 2000; 53(6):375-80
8. Lidia Hristeva, Ian Bowler, et al .Value of cerebrospinal fluid examination in the diagnosis of meningitis in the newborn. Arch Di: Childhood 1993; 69:514-7.
9. Rao B.N. Elbargathy M, et al.Epidemiology of acute bacterial meningitis in children from North-Eastern Libya. The Indian Practitioner1997; 50(3):199-207.
10. Johny V, Sainaba MK, Rajagopalan KC. Bacterial etiology of meningitis with special reference to staphylococci. Indian Pediatrics1987; 24:145-51.
11. Williamson M, Murti PK . A bacteriological study of purulent meningitis in children. Ind J Path Microbiology 1990; 33(2):157-60.
12. Corral J, Pepple J, Moxon R, Hughes WT.C-reactive protein in fluid of children with meningitis. J Pediatr1987; 99(3):356-69
13. Harishkumar, Kamlesh Harish et al. C-reactive protein in meningitides. Hid J Paediatr1996; 63:73-7.
14. William JM. Rapid and reliable techniques for the laboratory detection of bacterial meningitis. Am J Med1983; 119-23.

Dr Rajesh Kumar

Associate Professor, Department of Microbiology, Nalanda Medical College, Patna, India