Diagnosis Of Meningitis In Children Research Articles

Metagenomic sequencing of cerebrospinal fluid from children with meningitis.

The metagenome of a sample of cerebrospinal fluid (CSF) includes all the genomes found within that sample. Prior investigations have examined CSF samples of meningoencephalitis patients by metagenomic second generation sequencing, after preparation of both RNA and DNA libraries.1,2 An important proof-of-concept clinical study has now been published where the authors applied metagenomic third generation sequencing toward the diagnosis of meningitis in children and adults.3 The results were both informative and promising.

Серозные менингиты у детей: расширение диагностических возможностей

Обследованы 42 ребенка в возрасте 12 мес. — 10 лет, госпитализированных с предварительным диагнозом «менингит». Анализировали симптомы заболевания, результаты лабораторных исследований крови, ликвора, активность лактатдегидрогеназы (ЛДГ) ликвора. Тяжесть больных с серозными менингитами оценена по шкале тяжести AMSS. Была установлена статистически достоверно высшая активность лактатдегидрогеназы ликвора у пациентов с серозными менингитами. Активность ЛДГ зависела от уровня цитоза ликвора, концентрации в ликворе белка, общего количества лимфоцитов в периферической крови, что указывает на возможность использования исследования активности ЛДГ ликвора в качестве дополнительного показателя в диагностике серозных менингитов у детей.

Laboratory finding of CSF analysis in patients with meningitis at Elamin Hamid Pediatrics Hospital in Khartoum, Sudan

Bacterial meningitis in infants and children is a serious clinical entity with signs and symptoms that commonly do not allow distinguishing the diagnosis and the causative agents. The only method to determine if meningitis is the cause of these symptoms is a lumbar puncture. Lumbar puncture is the gold standard for the diagnosis and should be done in all suspected cases of meningitis unless contraindicated. Objectives: The purpose of this study is to identify the importance of the microbiological study of cerebrospinal fluid (CSF) in patients suspected to have acute meningitis. Despite the availability of all other investigations and Imaging for diagnosis of meningitis but CSF analysis remains the most available, accurate, and cheaper for diagnosis of meningitis in children. Methodology and result: This is a prospective study. 71 patients were included. All patients were clinically suspected to have acute meningitis. A lumbar puncture for CSF analysis was done for all patients. The data was collected and analysed. CSF culture was done. The culture was negative In 58 patients (81.7%) and positive in 13 patients (18.3%). Streptococcus was found in 3 patients (4.2 %), staphylococcus epidermidis in 2 patients (2.8%), E Coli in 2 patients (2.8%), klebsiella in 2 patients (2.8%), pneumococci in 2 patient (2.8%), salmonella in 1 patient (1,4%) and Bacilli in 1 patient (1.4 %). Recommendation: Lumbar Puncture (LP) remains the easiest, cheapest and accurate investigation for diagnosis of meningitis in children mainly in rural areas in Sudan and other developing countries. It’s mandatory to offer training for doctors and medical staff for doing lumber punctures safely and accurately and to offer well-equipped laboratories for such essential investigations. It’s not only the role of doctors and medical staff but is a governmental obligation as well. This can save a lot of sick children and prevent mortality and morbidity of acute meningitis in children.

Role of CBNAAT in diagnosis of tuberculous meningitis in children

Role of CBNAAT in diagnosis of tuberculous meningitis in children

COMPARING CSF PARAMETERS BETWEEN CHILDREN DIAGNOSED WITH BACTERIALAND ASEPTIC MENINGITIS

Introduction: Diagnosis of meningitis in children cannot rely on clinical examination. Present study aimed to evaluate the role of CSF examination in differentiating bacterial from aseptic meningitis in children less than 14 years of age. Methodology: This observational crosssectional study included children aged 1 month to 14 years with a diagnosis of meningitis. Children were classied as bacterial meningitis or aseptic meningitis. CSF examination was conducted to measure CRP, cell count, neutrophil count, lymphocytes, glucose levels and protein levels. Statistical comparison was made between children with bacterial meningitis and aseptic meningitis. Results: Children aged less than 2 years had the highest incidence of meningitis to the extent of 30.6%. CSF examination revealed than CRP was found to be positive in 81.82% of the patients with bacterial meningitis, while only 3.45% of the patients with aseptic meningitis had a positive CRP (p value < 0.001). It was observed that median cell count and neutrophil count were signicantly higher among patients with bacterial meningitis as compared to those with aseptic meningitis. While, median lymphocyte count was signicantly lower in patients with bacterial meningitis as compared to those with aseptic meningitis (p value < 0.001). Furthermore, we observed that CSF glucose less than 50% of that blood levels was observed in 81.82% of the patients with bacterial meningitis, which was signicantly higher than those diagnosed with aseptic meningitis (p value < 0.05). Conclusions: CSF CRP and biochemical parameters like cell count, neutrophils and glucose levels can aid in differentiating bacterial from aseptic meningitis

Diagnosis of aseptic meningitis in children

Diagnosis of aseptic meningitis in children

Diagnostic Value of Clinical and Laboratory Findings in Childhood Meningitis

Abstract Objective Acute meningitis in childhood is a serious infectious disease that requires immediate medical assessment to ensure appropriate treatment and healthy outcomes. The aim of this retrospective study was to evaluate clinical and laboratory findings in the diagnosis of acute meningitis in children. Materials and Methods Between February 2011 and March 2013, 258 children aged between 1 month and 18 years who were admitted to Konya Training and Research Hospital, Turkey, with clinically suspected meningitis and undergoing lumbar puncture were enrolled in the study. Patient charts were reviewed using a standardized data collection tool. Fifty-nine patients were excluded because of incomplete data or because they did not meet the enrollment criteria. Further statistical analysis was conducted on the remaining 199 patients. The diagnostic values of clinical and laboratory findings for acute meningitis were investigated. IBM SPSS 21.0 for Windows was used for the statistical analysis. Results Of the 199 patients (61.3% male; median age: 24 months), 101 (50.8%) were diagnosed with meningitis. A definitive diagnosis of bacterial meningitis was made in 16 patients, while 5 patients had probable bacterial meningitis. In addition, 80 patients diagnosed as aseptic meningitis and 47 of these patients had human enterovirus meningitis. Headache was more common in patients with meningitis. In patients without meningitis, the most common complaints were seizures or seizures accompanied by fever. Erythrocyte sedimentation rates (ESR), levels of cerebrospinal fluid protein, and cell counts in cerebrospinal fluid examinations were higher in the meningitis group. C-reactive protein, ESR, and procalcitonin higher than 22.55 mg/L, 36.5 mm/hour, and 6.795 mg/mL, respectively, indicated bacterial meningitis. Conclusion Our results showed that a combination of clinical and laboratory markers could facilitate recognition of bacterial meningitis in children.

Meningitis in children of early age. Criteria for early diagnostics

Meningitis is characterized by the prevalence of severe forms and it is often accompanied by life-threatening syndromes.Purpose. To determine the most informative clinical manifestations of meningitis in children in their first years of life to optimize early diagnosis and treatment.Materials and methods. The authors carried out a retrospective analytical study involving 47 cases of children hospitalized to the Republican Clinical Hospital for Infectious Diseases in 2014–2016. Their diagnose was based on the acute onset of the disease, characteristic clinical symptoms and the results of lumbar puncture. The laboratory diagnostics included a standard set of examinations.Results. Meningitis was diagnosed in 34 patients (72.3%), meningoencephalitis – in 13 patients (27.7%). 30 cases (63.8%) of meningitis / meningoencephalitis had a bacterial nature, and 9 cases (19.1%; p<0.01) had a viral nature. The most common bacterial pathogens of meningitis was Pneumococcus (10 cases), hemophilus bacillus (8). Str. agalactiae (6) and meningococcus (6). 38 (80.9%) patients had high febrile fever, 1005 of patients had weakness, drowsiness, changes in consciousness of varying severity, 29 patients (61.7%) had vomiting, 16 patients ( 34%) – headache, “brain” cry, 7 patients (15%) – hyperesthesia, a symptom of “mother’s hands”, 4 patients (8.5%) – forced posture, 34 patients (72.3%) had meningeal signs.Conclusion. The most significant symptoms of early diagnosis of meningitis in children are high febrile fever combined with drowsiness and retardation, vomiting without diarrhea.

338. The Use of Multiplex PCR Panel in the Diagnosis of Meningitis in Children

BackgroundCerebrospinal fluid (CSF) culture remains the gold standard for the diagnosis of bacterial meningitis, with viral PCR considered when clinically indicated. These tests can take 48–72 hours to result, during which patients receive empiric antimicrobial therapy and remain hospitalized. BioFire FilmArray™ Meningitis/Encephalitis panel (MEP) tests CSF for 14 bacterial, viral, and fungal pathogens with turnaround time of 1 hour. The objective of the study was to compare the results of the MEP to that of bacterial cultures, to evaluate the potential impact on length of stay (LOS) and antimicrobial use in our pediatric population.MethodsA retrospective review of data from MEP processed by Health Network Laboratories in children ≤18 years of age, from February 1, 2016 to December 31, 2017, at Lehigh Valley Children’s Hospital.ResultsA total of 220 MEP results were included in the study, with 46 positive samples. Of the positive samples, five were positive for bacterial organisms, four E. coli and 1 N. meningitidis. Four of the corresponding CSF cultures grew E. coli. The CSF culture corresponding to the MEP positive for N. meninigitidis, was negative, but both samples were collected after one dose of ceftriaxone. Of the positive MEPs, 89% were positive for a viral pathogen, with threesamples positive for Herpes Simplex Virus (HSV). MEPs had a lower average turnaround time of 6.9 hours when compared with CSF cultures of 48.8 hours. Average LOS was 5.7 days for those with a negative MEP compared with 3.8 days for those with a positive viral MEP other than HSV. Empiric antiviral treatment with acyclovir was initiated in 58 patients; patients with a negative MEP for HSV received an average of 3.13 doses.ConclusionThe study showed 100% concordance between MEP and CSF culture for E. coli meningitis. The discordance between CSF culture and MEP corresponding to N. meningitidis indicates that the increased sensitivity of MEP may play a role in the management of partially treated meningitis. The use of the BioFire MEP may be helpful in decreasing the average LOS in patients where a viral etiology other than HSV is identified. Faster turnaround time of MEP may decrease the number of antiviral doses in those with a negative MEP for HSV.Disclosures All authors: No reported disclosures.

Diagnostic accuracy of two multiplex real-time polymerase chain reaction assays for the diagnosis of meningitis in children in a resource-limited setting.

IntroductionAccurate etiological diagnosis of meningitis is important, but difficult in resource-limited settings due to prior administration of antibiotics and lack of viral diagnostics. We aimed to develop and validate 2 real-time multiplex PCR (RT-PCR) assays for the detection of common causes of community-acquired bacterial and viral meningitis in South African children.MethodsWe developed 2 multiplex RT- PCRs for detection of S. pneumoniae, N. meningitidis, H. influenzae, enteroviruses, mumps virus and herpes simplex virus. We tested residual CSF samples from children presenting to a local paediatric hospital over a one-year period, whose CSF showed an abnormal cell count. Results were compared with routine diagnostic tests and the final discharge diagnosis. We calculated accuracy of the bacterial RT-PCR assay compared to CSF culture and using World Health Organisation definitions of laboratory-confirmed bacterial meningitis.ResultsFrom 292 samples, bacterial DNA was detected in 12 (4.1%) and viral nucleic acids in 94 (32%). Compared to CSF culture, the sensitivity and specificity of the bacterial RT-PCR was 100% and 97.2% with complete agreement in organism identification. None of the cases positive by viral RT-PCR had a bacterial cause confirmed on CSF culture. Only 9/90 (10%) of patients diagnosed clinically as bacterial meningitis or partially treated bacterial meningitis tested positive with the bacterial RT-PCR.DiscussionIn this population the use of 2 multiplex RT-PCRs targeting 6 common pathogens gave promising results. If introduced into routine diagnostic testing, these multiplex RT-PCR assays would supplement other diagnostic tests, and have the potential to limit unnecessary antibiotic therapy and hospitalisation.

Use of polymerase chain reaction in the diagnosis of acute bacterial meningitis in children

To improve the epidemiologic surveillance of bacterial meningitis in Burkina Faso, cerebrospinal fluid samples from suspected acute bacterial meningitis in the Department of Pediatrics at Centre Hospitalier Universitaire Souro Sanou (CHU-SS), Bobo Dioulasso were tested by polymerase chain reaction (PCR) assay and results were compared to standard bacteriologic methods. The study was conducted over 13 months (March 2002 until March 2003) and included 170 suspected cases of meningitis in which lumbar punctures were performed. Cerebrospinal fluid samples were cultured on selective media and bacterial isolates were identified in 60 cases as follows; 56% Neisseria meningitidis, 22% Streptococcus pneumoniae, and 22% Haemophilus influenzae type b. Etiologic agents were detected by PCR in 77 cases as follows; 53% N. meningitidis, 21% S. pneumoniae, and 26% H. influenzae type b. Of the 162 samples evaluated by Gram stain, 64 (39.5%) were positive compared to 77 (45.5%) of the same samples that tested positive by PCR. Of the 88 samples selected for bacterial culture, 60 (68.2%) or 37% of the 162 total samples were positive. In the latex agglutination performed on 83 samples, 74 (89.2%), or 45.7% of the 162 total were positive. Sensitivity, specificity, positive predictive value, and negative predictive value of PCR measured against the results of standard cultures of Streptococcus were 76.92%, 97.3%, 83.33% and 96% respectively; for H. influenzae typeb, values were 84.6%, 89.18%, 57.89% and 97.05%, respectively and for N. meningitidis, values were 100%, 86.8%, 82.92%, and 100%, respectively. These results suggest that PCR is a useful technique for the evaluation of bacterial meningitis, when used in conjunction with bacterial cultures.

The Role and Reliability of Rapid Bedside Diagnostic Test in Early Diagnosis and Treatment of Bacterial Meningitis

To evaluate the role and reliability of rapid bedside diagnostic test in early diagnosis and treatment of bacterial meningitis in children using reagent strips. This prospective, single blinded study was conducted in the Department of Pediatrics of VMMC & Safdarjung Hospital, New Delhi in collaboration with the Department of Microbiology of VMMC & Safdarjung Hospital, New Delhi, over a period of 15 mo (August 2009 to Nov 2010). Seventy-five children aged 3 mo to 12 y admitted in the pediatric ward with suspected diagnosis of acute meningitis were included. All enroled patients underwent lumbar puncture. CSF samples were taken and divided in 2 parts for laboratory evaluation and rapid strip analysis. The sensitivity, specificity, positive predictive value and the negative predictive values of the reagent strips for the diagnosis of bacterial meningitis were calculated. Accuracy of the reagent strips was established using kappa statistics. Latex agglutination for antigen detection and microbiological culture were also done. Highly significant association was observed between CSF examination in routine laboratory method and dipstick method. The number of laboratory values that correlated were- for cells 71(94.63%), for protein 68 (90.67%), for glucose 68(90.67%) out of total 75 cases. The sensitivity and specificity of reagent strip in diagnosing acute bacterial meningitis were 96.7% and 97.8% respectively. The positive predictive and negative predictive values of reagent strip in diagnosing acute bacterial meningitis were 96.7% and 97.8% respectively. Staphylococcus aureus was found to be the most common organism isolated (50%). Thus reagent strip analysis is a very rapid, reliable and effective method for diagnosis of acute bacterial meningitis in children. Staphylococcus aureus was the most common organism isolated.

Is Cerebrospinal Fluid C-reactive Protein a Better Tool than Blood C-Reactive Protein in Laboratory Diagnosis of Meningitis in Children ?

This study aimed to test whether C-reactive protein (CRP) measurement could differentiate between different types of meningitis and become a routine test. A prospective study included 140 children admitted to Manipal Teaching Hospital, Pokhara, Nepal, between July 2009 and June 2011. The subjects had a blood test and detailed cerebrospinal fluid (CSF) analysis, including blood and CSF CRP levels. Of those admitted, 31.1% had pyogenic meningitis (PM), 26.2% partially treated meningitis (PPM), 33% viral meningitis (VM), and 9.7% tubercular meningitis (TBM), with 26.4% controls. Organisms were isolated in 12.5% of the cases by blood culture and 25% of cases through CSF culture. Blood CRP was positive in all groups, with the highest values in PM (53.12 ± 28.88 mg/dl) and PPM (47.55 ± 34.34 mg/dl); this was not statistically significant (P = 0.08). The CSF CRP levels were significantly higher (P <0.001) in PM (45.75 ± 28.50 mg/dl) and PPM (23.11 ± 23.98 mg/dl). The sensitivity and specificity of blood CRP was 90.62%, 88.88%, 64.7%, 70% and 32.4%, 30.97%, 24.52%, 26.12% and that of CSF CRP was 96.87%, 66.66%, 20.58%, 10% and 74.73%, 63.71%, 50.94%, 55.35% for PM, PPM, VM and TBM, respectively. Because of its high sensitivity, both CSF CRP and blood CRP can be used to screen for bacterial meningitis (both PM and PPM). CSF CRP screening yielded results with a higher specificity than blood CRP; hence, it can be a supportive test along with CSF cytology, biochemistry, and microbiology for diagnosing meningitis.

Serum Procalcitonin in Septic Meningitis

To evaluate the role of serum procalcitonin (PCT) in diagnosis of septic meningitis in children and its efficacy in differential diagnosis. The study included 40 children of septic meningitis admitted in pediatric ward with fever, headache, vomiting and seizure, up to 14y of age. The diagnosis of septic meningitis was based on clinical features; physical examination, blood and cerebrospinal fluid (CSF) cytochemical findings, gram's stain and bacterial culture. Fifteen cases of aseptic meningitis admitted during same period were also included in the study, and 15 children with normal CSF were taken as control. Serum PCT was measured by ELISA Kit. Serum PCT level was significantly higher in children with septic meningitis than those with aseptic meningitis or in controls (p < 0.001). In culture and gram's stain positive 7 cases, serum procalcitonin was significantly elevated (24,768.21 ± 6,567.45pg/mL) than aseptic meningitis(14,451.24 ± 4,266.15pg/mL) (p < 0.001). Further its level was found significantly elevated in partially treated septic meningitis as compared to aseptic meningitis cases (p < 0.001). At optimum cut off value of ≥ 5,000pg/mL, based on area under ROC curve, PCT showed sensitivity, specificity, positive predictive value and negative predictive value of 98.5%, 93.5%, 98.6% and 93.3% respectively. Serum PCT with cut off level of 15,000pg/ml showed sensitivity, specificity, PPV and NPV of 92%, 67%, 91.4% and 71.4% respectively for the differentiation of septic from aseptic meningitis. Serum PCT may be used as diagnostic marker for septic meningitis and its differentiation from aseptic meningitis.

Diagnostic Accuracy of Clinical Symptoms and Signs in Children With Meningitis

The diagnostic accuracy of the classic symptoms and signs of meningitis in infants and children has not been established. All children aged 2 months to 16 years with clinically suspected meningitis were eligible for this prospective cohort study at 2 large medical centers between February 2006 and October 2007. Exclusion criteria were severe chronic disease, severe immune deficiency, or idiopathic intracranial hypertension. The emergency department physician obtained information on clinical symptoms and signs and cerebrospinal fluid analysis. Meningitis was defined as white blood cell count of 6 or higher per microliter of cerebrospinal fluid. A total of 108 patients with suspected meningitis were enrolled. Meningitis was diagnosed in 58 patients (53.7%; 6 bacterial and 52 aseptic). Sensitivity and specificity were 76% and 53% for headache (among the verbal patients) and 71% and 62% for vomiting, respectively. Photophobia was highly specific (88%) but had low sensitivity (28%). Clinical examination revealed nuchal rigidity (in patients without open fontanel) in 32 (65%) of the patients with meningitis and in 10 (33%) of the patients without meningitis. Brudzinski and Kernig signs were present in 51% and 27% of the patients with meningitis, respectively, and had relatively high positive predictive values (81% and 77%, respectively). Bulging fontanel in patients with open fontanel was present in 50% of the patients with meningitis but had a positive predictive value of only 38%. Classic clinical diagnostic signs have limited value in establishing the diagnosis of meningitis in children and should not be the sole determinants for referral to further diagnostic testing and lumbar puncture.

Proton MR CSF analysis and a new software as predictors for the differentiation of meningitis in children

This article describes proton MR spectroscopic analysis of cerebrospinal fluid of 167 children suffering from meningitis and 24 control cases. Quantification of 12 well-separated and commonly observed cerebrospinal fluid metabolites viz., beta-hydroxybutyrate, lactate, alanine, acetate, acetone, acetoacetate, pyruvate, glutamine, citrate, creatine/creatinine, glucose (total) and urea was carried out using Bruker's NMRQUANT software with respect to a known concentration of sodium-3-(trimethylsilyl)-2,2,3,3-d4-propionate (TSP), serving as an external reference. The assignment of urea in CSF is reported for the first time by NMR. The presence of cyclopropane, observed for the first time in tuberculous meningitis overall in 85.1% of cases, acts as a finger-print marker for the differential diagnosis. Multivariate discriminant function analysis was carried out for the proton MR-detected metabolite information and the clinical symptoms data of the meningitis and control cases to find the important descriptors for classification, followed by a re-validation of the entire database. It was found that the control could be differentiated from the disease group with a success rate of 96.4%, followed by the differential diagnosis of tuberculous meningitis with a corresponding value of 77.2%. Excluding the presence of cyclopropane, bacterial meningitis could be classified 84.4% correct and viral meningitis with a rate of 83.3%. It is proposed that the NMR spectroscopic information, along with other routine clinical features, may serve as an additional diagnostic tool for the differential diagnosis of meningitis in children.

Diagnosis of meningitis with reagent strips

OBJECTIVE: To determine the usefulness of reagent strips in the evaluation of pleocytosis, cerebrospinal fluid glucose and protein levels for early and rapid diagnosis of meningitis in children. METHODS: We included cerebrospinal fluid samples of 164 children admitted to the outpatient clinic of Communicable Diseases of the General Pediatric Center (Fundação Hospitalar do Estado de Minas Gerais, CGP-FHEMIG) during the daytime hours from May of 1997 to May 1999, and who presented with clinical suspicion of meningitis. Patients ranged in age from one month to 12 years (median 12 months). Results from the cytological and biochemical assay (cellularity, cerebrospinal fluid glucose and protein levels) were obtained from 154 patients. These results were subsequently compared with the reaction of cerebrospinal fluid in reagent strips. RESULTS: The cytological and biochemical assay identified 43 cases of probable bacterial meningitis, 19 of probable viral meningitis, and 83 with no alterations. According to the reagent strips, there were 41 cases of probable bacterial meningitis, 2 of probable viral meningitis, and 71 with no alterations. By comparing the results of reagent strips and those of the cytological and biochemical assay, we obtained values for sensitivity, specificity, positive and negative predictive values, and accuracy (respectively 90.7; 98.1; 95.1; 96.4; and 96.1). Statistical analysis using McNemer test did not indicate significant differences between the two methods in the diagnosis of bacterial meningitis (P=0.68). Kappa statistics indicated a high level of agreement between the tests (P<0.0001). CONCLUSIONS: Our results suggest that reagent strips may be a useful additional resource in the diagnosis of bacterial meningitis, especially when it is difficult to collect a sufficient amount of cerebrospinal fluid or to indicate the initial treatment.

A protocol for testing expert-system reliability.

We set out a protocol for giving a computerised medical decision system the label of expert-system meaning that its responses are of the same standard as those of an expert. We apply it to the validation of an expert-system, MENINGE, which is applied to diagnosis of meningitis in children. The proposed protocol can be widely used since it doesn't refer to the existence of correct responses for therapy or diagnosis, and since it involves simple statistical computations. First this validation rests on a comparison of agreement among experts and among physicians new to medical practice. Secondly, the agreement of the system with the experts is compared to the agreement of the system with physicians new to medical practice. In order to perform this comparison we recommend a standard agreement measure, the choice of which is an important issue in this paper.

Cerebrospinal fluid C-reactive protein in the diagnosis of meningitis in children.

The mortality rate of bacterial meningitis in infants and children is still high (40-50%). Such a mortality rate can be reduced by establishing a prompt and accurate diagnosis. Until now the diagnosis of meningitis is still an important clinical problem. The examination of cerebrospinal fluid C-reactive protein had been done in 44 clinical meningitis patients in the Paediatrics Department, Dr. Sardjito General Hospital qualitatively by means of latex agglutination slide test. Cerebrospinal fluid C-reactive protein was positive in 90% (18/20) of bacterial meningitis patients compared to 8.3% (2/24) of non bacterial meningitis patients. The sensitivity and specificity of cerebrospinal fluid C-reactive protein were 90% and 91.7% respectively and these values were more sensitive and specific than those of white cell count, absolute polymorphonuclear, glucose and protein levels and the cerebrospinal fluid smear (50-80% and 80-91% respectively) which had been performed in the diagnosis of meningitis. It can be concluded that the examination of cerebrospinal fluid C-reactive protein can be used as a diagnostic tool of bacterial meningitis.

POSTGRADUATE COURSE

Discussion of clinical recognition and differential diagnosis of purulent meningitis in children, and especially infants, is followed by an outline of therapeutic regimens currently employed at the Hospital for Sick Children. The clinical features and use of steroids in measles encephalitis are outlined. The differential diagnosis between poliomyelitis and the Guillain-Barré syndrome is discussed, together with points regarding early management of respiratory complications.