Research Article Role of Clinical Presentations and Routine CSF Analysis in the Rapid Diagnosis of Acute Bacterial Meningitis in Cases of Negative Gram Stained Smears Rabab Fouad, 1 Marwa Khairy, 1 Waleed Fathalah, 1 Taha Gad, 2 Badawy El-Kholy, 3 and Ayman Yosry 1 1 Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University, Cairo 11562, Egypt 2 Shebin El-Kom Fever Hospital, Egyptian Ministry of Health, Menouia 12489, Egypt 3 Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt Correspondence should be addressed to Marwa Khairy; marwakhairy79@hotmail.com Received 13 January 2014; Accepted 3 March 2014; Published 3 April 2014 Academic Editor: Carlos E. P. Corbett Copyright © 2014 Rabab Fouad et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background and Aim. Bacterial meningitis is a lethal, disabling endemic disease needing prompt antibiotic management. Gram stained smears is rapid accurate method for diagnosis of bacterial meningitis. In cases of negative gram stained smears diagnosis is delayed till culture results. We aim to assess the role of clinical presentations and routine CSF analysis in the cost-efective rapid diagnosis of negative gram stained smears bacterial meningitis. Methods. Cross sectional study including 623 acute meningitis patients divided into two groups: bacterial meningitis and nonbacterial meningitis groups. he clinical presentations, systemic inlammatory parameters, and CSF analysis were evaluated and compared in both groups. Results. Altered conscious level, localizing neurological signs, Kernig’s and Brudzinski’s signs together with peripheral leucocytosis (>10.000/mm 3 ), high CRP (>6) together with high CSF protein (>50 gl/dL), CSF neutrophilic count (≥50% of total CSF leucocytic count), and low CSF glucose level (<45 gm/dL) and CSF/serum glucose ≤0.6 were signiicantly diagnostic in bacterial meningitis patients. From the signiicant CSF analysis variables CSF protein carried the higher accuracy of diagnosis 78% with sensitivity 88% and speciicity 72%. Conclusions. High CSF protein (>50 mg/dL) together with plasma inlammatory markers and CSF cytochemical parameters can diagnose bacterial meningitis in gram stain negative smear till culture results. 1. Introduction Acute bacterial meningitis is a major cause of death and disa- bility worldwide. It afects over one million people yearly, with higher incidence among developing countries and in speciic geographic areas [1]. Meningitisis an endemic disease in Egypt; S. pneumonia meningitis is currently the leading cause of meningitis in Egypt and has the highest mortality rates among meningitis cases especially in patients less than one year of age [2, 3]. Acute meningitis is caused by a variety of infectious agents. he most serious form is caused by pyogenic bacteria, such as S. pneumoniae, N. meningitidis, and H. inluenzae [4]. Viruses are the most common cause of aseptic meningitis, primarily enteroviruses, together with numerous nonviral and noninfectious etiologies [5]. Diferentiating bacterial from nonbacterial meningitis is very important in deciding treatment. Bacterial meningitis is a life-threatening neurological condition and needs prompt parenteral antibiotics, compared to viral and aseptic menin- gitis which carries relatively better outcome [6]. Delay in the start of proper therapy introduces the potential for increased morbidity and mortality, if the patient does indeed have acute bacterial meningitis [5]. CSF culture is highly speciic but lacks sensitivity, espe- cially when antimicrobials have been given as well as the time needed till results appear [7]. Someinvestigators document bacterial meningitis only in patients with positive CSF culture Hindawi Publishing Corporation Journal of Tropical Medicine Volume 2014, Article ID 213762, 7 pages http://dx.doi.org/10.1155/2014/213762