DAC DIEM LAM SANG VA CAN LAM SANG 6 BENH NHAN VIEM NAG - MANG NAG DIEU TRI TAI BENH VIEN 108 (3/2014 - 5/2015)
Nguyen Dang Mgnh'.
Muc tieu: Tim hidu ca cau tac nfaan gay benh, dac diem lam sang, can lam sang d benh nfaan (BN) viem mang nao (VMN) - nao. Doi tugng vd Phuangphdp: Ngfaign curu tien ctiu, md ta tren 108 BN VMN nao tai Vien lam sang cac benh Truydn ititigm, Benfa vien Trung uomg Quan dpi 108 tu tfaang 3 nam 2014 dgn tfaang 5 nam 2015. Ket qud vd kit lugn: Yi kfauan cfaidm ty le cao nfaat (38,9%), tigp tiieo la vi rtit (27,8%), lao (22,2%) va ky sinb tiling (11,1%). Trieu cfating lam sang ctia VMN nhiem kfauSn thudng gap la hdi cfating nfaiem trung (HCNT, 100%), hdi cfating mang nao (HCMN, 100%) va rdi loan y tfatic (RLYT, 47,6%). 6 BN viem nao vi rtit, faay gap nhdt la HCMN (80%), HCNT (60%) va RLYT (20%). Ty le BN cd HCNT va HCMN !a nhu nfaau d ca BN lao mang nao (LMN) va VMN do ky sinfa trting (KST), cfaiem ty le lan lupt la 75% va 33%. Gia tri trung buih cua PCT ldn nhdt d BN VMN nhiem khuSn (11,79 ± 2,29ng/ml) va nhd itiiat d BN VMN do KST (0,20 ± 0,20ng/ml). Sd lucmg tnmg binh ctia bacfa cau trong dich nao ttiy ldn nfaat d BN VMN rtiiiem kfauan (1547 ± 3 te bao/mm'), nhd nhat d benfa rtiian viem nao vi rtit (76 ± 8 te bao/mm^). Gia tri trung binfa ctia ndng dp protein trong dich nao tuy ldn nfait d BN LMN (2,95 ± 3,67g/l) va VMN nfaidm khuSn (2,06 ± 2,12g/l).
Tir kboa: \^em nao - mang nao, lam sang, can lam sang.
DJiTVANDE
Viem nao - mang nao (VNMN) la mot tiong nhutig benh nguy hiem thudng gap tien toan the gidi vdi nhieu vu dich ldn, ty le mac va ty le t t i vong (TV) cao gay nhOtig hau qua nang ne ve stic khde va kinh tet^. O My khoang 19000 ca nhap vien va TV khoang 1400 ca moi nam do viem naoi^; d chau A VMNN cung la mot van de dac biet nghiem trong vdi nhieu vu dich ldn nhU viem nao Nhat Bant^l Tbeo thong ke cua WHO hang nam tren the gidi cd khoang 500.000 trudng hdp viem mang nao (VMN) do nao md cau (NMC), vdi khoang 50.000 trUdng hdp tir vong. Day la nhdm benh co ty le hi" vong dting dau trang 10 benh cd ty
"'Ken Ldm sdng cdc bftth Truyen nhiem. Bfnh vifn Tnmg tnmg Qudn dgi 108.
N g i y nb^a bai: 14/7/2016- N g i y pliin bien xoDg: 26/7/2016.
N g i y d n y l t a a n g : I8/S/2016
Ngiriri chju tracli nhifm noi dung khoa h ^ c : Nguyin Ddng M(/nh, yi?n Ldm sdng cdc b4nh Truyen nhiem, B?nh vifn Trung uang Qudn dpi 108.
Di?n thoQi. 0975598989. E-mail: drmanha4bl08@gmail com
le t t i vong cao d Viet Nam. Phan biet Viem mang nao mii (VMNM) vdi Viem mang nao do vi mt (VMNVR) trong giai doan sdm thUdng rat kho khan. Cac xet nghiem chan doan xac dinh thudng dUdc sti dung la: cay djch nao tuy (DNT), nhupm gram, tim khang nguyen hda tan trong DNT Nhiit^
xet nghiem nay co do dac hieu cao nhutig dp nhay thap, dac biet la cac trUdng hdp da dUdc dieu tri Wiang sinh trUdc do. Ben canh nhifng xet nghiem nay, ain co nhiing xet nghiem cd the gdi y nguyen nhan VNMN la do vi khuan hay vi rut nhU cong thu'c bach cau, PCT, CRP mau, so lUdng va cong t h i i t bach cau, lactate, nong do protein va dudng trong DNT. Ngay nay, vdi sU tien bp ciia ky thuat y sinh hpc cho phep chan doan dUdc nhanh hdn, nhieu hdn tac nhan gay nhiem khuan he than kinh trung Udng giup cho cac thay thudc cd sU \\Sa chpn thuoc dac hieu kjp thdi ctiu song dUdc benh nhan va ngan chan di chutig nang ne. Nham dap iing nhu cau nang cao chat lUdng chan doan dieu tri tai Vien lam sang cac benh Tnjyen nhiem, Benh vien Trung uWng Quan dpi 108, chung toi tien hanh
6 -TRUY^I»i&«VI$TNAM*s6 3(15)-2016
nghien ciiU de tai nay vdi cac muc tieu: Tim hieu cd cau tac nhan gay benh, dac diem lam sang, can lam sang cac benh nhan viem nao - mang nao tai Vien lam sang die benh Truyen nhiem, Benh vien Trung Udng Quan dpi 108 t t i thang 3/2014 den thang 5/2015.
D d i TU'ONG VA PHU'ONG PHAP
Ddi tu'dng nghien cuti: Gdm 108 benh nhan dUdc chan doan lam sang la viem nao - mang nao dieu tn tai Vien lam sang cac benh Truyen nhiem, Benh vien Trung Udng Quan doi 108 t t i thang 3/2014 den thang 5/2015.
Tieu chuin Ida chon: la nhOtig benh nhan dUdc chan doan: viem mang nao - nao do vi khuan, vi rut, lao, ky sinh tiung. Tuoi: tien 16.
77eu chuan loai bif: Benh nhan HIV/AIDS. ChUa loai tru"
dUdc chan doan dot quy nao cap.
Phu'dng phap: Nghien ctiu tien ctiLi, md ta.
Cach thu'c tien hanh nghien citu: Hoi tien sti, benh sti va danh gia cac trieu chting, dau hieu lam sang. Lam cac xet nghiem cong tiitic mau, cac xet nghiem thudng qui va chup phim CT va, hoac MRI sp nao. Xet nghiem DNT:
Danh gia mau sac, ap lUc, phan tfch hoa sinh, te bao va lay 2ml lam xet nghiem PCR. Cac mau benh pham cay, soi trUc tiep se dUdc lay cung thdi diem vdi mau benh pham lam PCR. Cac mau benh pham mau lam xet nghiem ELISA se dUdc gui cang sdm cang tot tdi phdng xet nghiem. Tat ca cac thong tin ve benh nhan, trieu chting lam sang, ket qua xet nghiem can lam sang deu dUdc dien vao benh an nghien ctiu. Thong tin ve benh dUdc tap hdp phan loai theo tuoi, gidi, nhdm tac nhan gay benh, ket qua xet nghiem mau, DNT, ket qua chup MRI sp nao va PCR phat hien mam benh trang DNT.
Thu thap va xu' ly so lieu: XU ly sd lieu tren phan mem SPSS 17.0. SU khac biet cd y nghla thong ke khi p < 0,05.
KET QUA VA BAN LUAN
Dac diem chung cua nhdm nghien cuti.
Bang 1 . Dac diem ve tuoi va gidi.
Tuoi va gidi
Tuoi
Gi6i
<20 20-40
>40 Nam NU
n = 10S 6 38 64 62 46
Ty le % 5,6 35,2 59,2 57 43
Trong nghien ciiti ciia chiing toi, ty le benh nhan nam mSc benh tinh chung cho tat ca doi tUdng nghien ctiu nhieu hdn so vdi benh nhan nti (57% so vdi 43%). Ket qua nghien cuti cua chiing toi cung phu hdp vdi ket qua nghien ctiu cua tac gia Codrina Bejan va cpng sU. Trong nghien ctiu do, Codrina Bejan thay ty le benh nhan Nam la 63,2%, ty le benh nhan NC la 36,8%t^i. Tuoi trung binh ciia cac benh nhan trong nghien ctiu ciia chiing tdi la 46,19 ± 19,29 tuoi. Ty le mac benh nhieu nhat d nhom tuoi tren 40 (chiem 59,3%). Ket qua nghien ctiu ciia chiing tdi cung phu hdp vdi ket qua nghien cuti ciia cac nghien culi trUdc day. Le Tan Phong va cpng sU cho thay ty le mac benh nhieu nhat d nhdm tuoi tien 40 tuoi (chiem 83%)[^i. Nhdm tuoi tien 40 tuoi la dp tuoi lao dpng chinh trong xa hpi, cd the tham gia vao tat ca cac hoat dpng lao dpng, cac cdng viec nang nhpc, hdn njj^ day cung la lii^
tuoi cd stic de khang bat dau suy giam. Do vay, d dp tuoi nay rat de mac cac benh nhiem triing than kinh khi ma tlnh hinh iUu hanh cac benh tiuyen 6 nUcfc ta con kha cao.
Dac diem lam sang
M
Bleu do 1 : Dac diem lam sang theo nhom tac nhan gay benh
Cac trieu chUng lam sang cua viem mang nao nhiem khuan thudng gap la hpi chutig nhiem trung (100%), hoi chting mang nao (100%) va rdi loan y thu'c (47.6%). 6 benh nhan viem nao vi rut hay gap nhat la hpi chting mang nao (80%), hoi chuhg nhiem trung (60%) va roi loan y thUc (20%).
Ty le benh nhan co hoi chUng nhiem triing va hpi chting mang nao la nhU nhau d ca benh nhan lao mang nao va viem mang nao do ky sinh triing, chiem ty le lan lUdt la 75% va 33%. Ket qua nghien ctiu ciia chiing tdi cung phu hdp vdi ket qua nghien cUu ciia Nguyen Van Duyet va cong sU, cac trieu chting lam sang d benh nhan viem mang nao nhiem khuan thudng gap la hoi chting nhiem trung (100%), hpi chting mang nao (100%) va rdi
T R U Y ^ N H l i M V l E T N A M * s 6 3 ( 1 5 ) - 2016 - 7
loan y Oitic (64,5%)W. Cac tiieu chting lam sang 6 benh nhan lao mang nao tiong nghien ciiU ciia chiing toi cung phil hdp vdi ket qua nghien a i u ciia Nguyen Thi Ha va cpng sU, hpi chiitig nhiem trung (80%), hoi chting mang nao (32,3%). Tuy nhien ty le benh nhan co dau hieu than kinh khu hu la tUdng doi cao (20,7%)[2i.
Cac trieu chting lam sang nhU sot, co ciTng va Kemig(+) la nhuhg tiieu chutig dien hinh ciia viem mang nao nhiem khuan, vay nen, nhiJhg tiieu chting nay chiing ta gap 100% d cac benh nhan viem mang nao nhiem khuan. Trong tat ca cac benh nhan tham gia nghien cuU ty le benh nhan co dau hieu than kinh khu tru la thap, chi&n ty le cao nhat d nhom w'em mang nao nhiem khuan (4,7%). Dieu nay co the dUdc giai thich la do hau het cac benh nhan dUdC nhap vien cd chan doan va dieu tri sdm.
Dac d i a n can lam sang Mam benh
Phan bd mam benh dUdc tiinh bay ti bieu do 2 va bang 2
• VikhuSn
• vinit
• 27 8% ( 30 )
Bieu do 2. Nhom tac nhan gay benh ( n = 108) Chiem ty le cao nhat la nhom tac nhan do vi khuan (chiem 38,9%), tiep tiieo la nhom tac nhan do vi nit (27,8%), do lao (22,2 % ) , va nhdm tac nhan do ky sinh
tiling chiem ty le thap nhat (11,1%). Dieu nay co the giai tiiich bdi Benh vien Trung Udng Quan doi 108 la benh vien tuyen cudi ciia toan quan, thudng xuyen tiep nhan nhffng benh nhan nang t t i tuyen dudi chuyen len. Trong cac nhom tac nhan gay benh nhiem khuan than kinh trung Udng thi viem mang nao nhiem khuan va viem nao vi rut la hai mat benh dien bien nang va cap ti'nh, ty le t t i vong cao neu khdng dUdc chan doan va xii" tri kjp thdi. Nhom tac nhan do lao va ky sinh bting thUdng dien bien t t i tii, CO the dieu tri dUdc d cac benh vien tuyen dUdi.
Bang 2. Phan bo mam benh theo nhom tac nhan gay benh
Tdc nhan
Vi Idiuan
Vinit
Ky sinh trung
Mambenh Nao mo <^u Uen cau Ion A.baumannti Nliom idiac HSV Nliom idiac Toxoplasma gondii Toxocara canis Nliom kliac
n 10 10 2 20 8 22 2 3 7
%
23,8 23,8 4,7 47,7 26,7 73,3 16,7 25 58,3 Nhom tac nhan do vi khuan cd 22 ca djnh danh duWc mam benh, trong do nao md rau va lien cau ldn chiem ty le bang nhau 23,8% (10 ca), co 2 ca do A.baumannii (4,7%). Nhom tac nhan do vi nit cd 8 ca dinh danh dUdc mam benh deu la HSV, chiem 26,7%. Nhom tac nhan do ky sinh triing co 5 ca djnh danh dUdc mam benh, tix)ng do cd 2 ca do Toxoplasma gondii chiem 16,7%, va 3 ca do Toxocara canis chiem 25%.
Bang 3. Bien doi bach cau trong mau
Tac nhan Bach cau (G/L) Tang > lOG/L Binh ttiuJrng (4 -10 G/L) Gia tri tiung binii
VI khuan (n = 42) n 30 12
%
71,4 28,6 16,0 ± 7,0
Vinit (n = 30) n 16 14
%
53,3 46,7 10,0 ± 3,1
Lao (n = 24) n 16 8
%
66,7 33,3 10,2 i 2,2
Ky sinh ttilng (n = 12) n 8 4
%
66,7 33,3 10,8 ± 3,4
Tong so n 70 38
%
65 35 13,6 ± 1,0
P
<0,05
8 - T R U Y ^ W a ^ V I E T N A M * SO 3(15) - 2016
Phan ldn benh nhan tiding nghien ciili nay cd so lUdng bach cau trong mau tang ldn hdn lOG/L (chiem 65%), tieng dd gia trj bach cau mau tiung binh la 13,6 ± 1,0G/L.
Weng d benh nhan viem nao vi riit, ty le bach cau tiong mau tang va ty le bach cau binh thuting la tUdng dUdng nhau. SU khac biet ve gia tri bach cau mau trung binh theo nhom tac nhan gay benh la co y nghTa thong ke (P
< 0,05). Ket qua nghien ctiu ciia chiing toi cling ttidng tU vdi ket qua nghien ctiu ciia Nguyen Van Duyet va cdng sU, CO so lUtfng bach cau trang mau tang ldn hdn lOG/L (chiem 77,4%), trong dd gia tij bach cau mau trung binh la 13,7 ± 5,1G/L['l Ket qua nghien cuti ciia chiing tdi cung ttidng t u vdi ket qua nghien ctiu ciia Codrina Bejan va cpng sU, CO so lUdng bach c i u trong mau tang ldn hdn lOG/L (chiem 70%)'^'. Sd lUdng bach cau trong mau tang cao phan anh tinh tiang nhiem trung cua cac benh nhan nhiem khuan than kinh trung Udng.
Bang 4. Bien doi Procalcitonin (PCT) trong mau.
T a c n h a n g a y b e n h PCT ( n g / m l )
Gia tri nho nhat Gia trj icfn nhlit
Gia tri trung binh ± SD k h u a n
o,os 100 11,79 ±
2,29 V i rOt
0,02 5,34 0,79 ±
1,34 U o
0,08 2,00 0,44 ±
0,56 Ky sinh t r f l n g
0,02 0,50 0,20 ±
0,20 P
<0,05
Co 104/108 benh nlian (96,2%) co gia tri procalci- tonin (PCT) I6n hdn 0,05ng/nil. Gia tri trung binh cua PCT I6n nhat d benh nhan viem mang nao nhiem Ithuan (11,79
± 2,29ng/ml) va nho nhat i5 benh nhan viem mang nao do ki sinh triing (0,20 ± 0,20ng/ml).
Gia tri trung binh ciia PCT 6 benh nhan viem nao vi rut (0,79 ± l,34ng/ml) ldn han gap khoang 2 lan gia tri trung binh cua PCT cl benh nhan lao mang nao (0,44 ± 0,56). SU khac biet ve gia tri trung binh PCT trong mau theo nhom tac nhan gay benh la co y nghla thong ke (P < 0,05).
Bang 5. Bac diem so lu'dng bach cau djch n i o tuy.
Tkc n h a n
B C ( t e b a o / m m 3 ]
Gia tri nho nhSt Gia tn Icin nhat
Gia tri trung binh ± SD V i ^ I d i u a n
30 12800 1547 ± 3
V i r u t 4 230 76 ± 8
Lao
10 700 177 ± 2
Ky sinh t r u n g 30 720 201 ± 260
P
<0,05
Gia tri trung binh ciia bach cau trong djch nao tiiy Idn nhat d benh nhan viem mang nao nhiem khuan (1547 ± 3 te bao/mm^), nhd nhat 6 benh nhan viem nao vi nit (76
± 8 te bao/mm^). Gia trj trung binh cua bach cau trong djch nao tuy la tUdng dUdng nhau 6 benh nhan viem mang nao do ky sinh trung va viem mang nao do lao.
Phan ldn benh nhan viem mang nao nhiem khuan va viem mang nao do ky sinh trung co so lUdng te bao bach cau tinng djch nao tiiy >100 te bao/mm^ chiem ty le lan lupt la 90,5% va 66,7%. Phan Idn benh nhan viem nao vi nit cd so lUdng bach cau tiong dich nao tiiy < 100 te bao/mm^ O benh nhan lao mang nao, ty le benh nhan cd so lUdng bach rau tix)ng dich nao tiiy > 100 te bao/mm^ va
< 100 te bao/mm' la tUdng dUdng nhau (50%). SU khac biet ve gia tij bach cau tiung binh trang djch nao tiiy theo nhom tac nhan gay benh la co y nghTa thong ke (P < 0,05).
Ket qua nghien culi cua chiing toi phii hdp vdi ket qua nghien ciiU ciia Codrina Bejan va cpng su^''^. Trong nghien ctiu cua Nguyin Thj Ha va cpng sU thi 6 benh nhan lao mang nao, ty le benh nhan cd sd ludng bach rau trang djch nao tliy > 100 te bao/mm^ va <100 te bao/mm^ la tUdng dUdng nhau (50%)^.
Bang 6. Dac diem ve bien 66\ nong do Protein trong djch nao tuy
T a c n h a n
Protein ( g / l ) Gia tn ntio nliat Gia Iri Ifln nhat
Gia tn trung ismti ± SD k h u a n
0,35 8,82 2,06 ±
2,12 Vi r u t
0,33 3,70 0,93 ±
0,93 Lao
0,60 11,69 2,95 ± 3,67
Ky sinh trlJng
0,40 1,87 0,88 ±
0,52 P
<0,05
Gia tri tiung binh ciia nong dp protein Irong dich nao tuy ldn nhat d benh nhan lao mang nao (2,95 ± 3,67g/l) va viem mang nao nhiem khuan (2,06 ± 2,12g/l). Gia trj trung binh cua nong dp protein trong djch nao tuy la tUdng dUdng nhau d benh nhan viem mang nao do ky sinh trung (0,88 ± 0,52g/l) va viem nao vi nit (0,93 ± 0,93g/l). SU khac biet ve gia tri tmng binh ciia nong dp protein trong djch nao ttiy theo nhom tac nhan gay benh la CO y nghia thong ke (P < 0,05). Ket qua nghien ciiU cua chiing toi phu hdp vdi ket qua nghien ctiu ciia Nguyen Van Duyet va cong sU. Trong nghien ctiu do, nhom viem mang nao nhiem khuan co 54,8% benh nhan cd nong dp
TRUYiNNHI&UIVieTNAM*sd 3(15) - 2016 - 9
protein tU 1 - 3g/l. Gia tri trung binh ciia nong do protein trong djch nao tiiy la 2,50 ± l,5g/iw. Mpt nghien ciru khac cho thay nong dp protein trung binh trong djch nao tiiy d benh nhan viem mang nao nhiem khuan la 2,05 ± 0,5g/lt'']. Ket qua nghien ciTu ciia chiing toi phu hdp vdi ket qua nghien ciTu ciia Nguyen Thj Ha va cong sU, co nong dp protein trung binh trong djch nao tuy d benh nhan lao mang nao la 2,53 ± 2,01glP-\
KETLUAN
Vi khuan, vi riit, lao va ky sinh trung la nhuTig mam benh gay viem nao - mang nao chu yeu vdi cac ty le tiidng ting la 38,9%, 27,8%, 22,2% va 11,1%.
Viem nao - mang nao nhiem khuan thudng gay hoi
chiing nhiem trimg (100%), hoi chiitig mang nao (100%) va rdi loan y thtic (47,6%). Viem nao mang nao vi rut thudng co hpi chiiVig mang nao (80%), hpi chting nhiem triing (60%) va rdi loan y thu'c (20%). Ty le benh nhan co hpi chting nhiem trung va hpi chiing mang nao la nhU nhau d ca benh nhan lao mang nao va viem mang nao do ky sinh triing, chiem ty le lan lUdt la 75% va 33%. So lUdng trung binh ciia bach cau trong djch nao tiiy ldn nhat 6 benh nhan viem mang nao nhiem khuan (1547 ± 3 te bao/mm^), nho nhat d benh nhan viem nao vi rut (76 ± 8 te bao/mm^). Gia tri trung binh cua nong dp protein trong dich nao tiiy Idn nhat d benh nhan lao mang nao (2,95 ± 3,67g/l) va viem mang nao nhiem khuan (2,06 ± 2,12g/l).
TAI LIEU THAM KHAO
1. Nguyen Van Duyet (2012). Nghien citu dac diem lam sang, can lam sang va can nguyen d benh nhan viem mang nao mii sau phau thuat than kmh. Luan van thac sy.
Oai hpc Y Ha Noi.
2. Nguyen Thj Ha (2000). Nghien c(fu dac diem lam sang, can lam sang ciia lao mang nao d ngucfi ldn theo giai doan benh. Luan van thac sy. -Dai hoc Y Ha Npi.
3. Le Tuan Phong (2002). Lao mang nao. Lao mang nao, lao mang ngoai tim, lao mang bung 2002. Nha xuat ban y hpc, tr. 13 -177.
4. Bejan C, Dorobat G (2009). Bacterial meningitis postoperative. An access study of 68 rases of infectious diseases HospitaliseD Clinic of lasi, between 2004 - 2008.
Therapeutics, pharmacology and cliniral toxicology, p. 361 -364.
5. Chong H (2005). Epidemiology of central nervous system infections in Asia, recent trends. Neurology Asia 10, p. 7 - 1 1 .
6. George B. P, Venkatesan A (2014). Encephalitis Hospitalization Rates and Inpatient Mortality in the United States, 2000 - 2010. PLoS ONE, 9(9), p. 104169.
1 0 - TRUYINNHIEM V I E T N A M * SO 3(15) - 2016
CLINICAL AND PRACLINICAL CHARACTERISTICS OF PATIENTS SUFFERRING FROM MENINGOENCEPHALITIS
Summary Objective: Jo investigate the model of the pathogens, clinical, paradinical characteristics of patients sufferring from meningoencaphalitis. Subject and Method: A prospective and descriptive study was conducted on 108 patients w/ith meningoenraphalitis at the Institute of Clin- ical Infectious Diseases, 108 Military Central Hospital from March 2014 to May 2015. Result and conclusions: Bacte- rial agent accounts for tiie highest percentage (38,9%), whilst viral, tuberculous and parasitic agents account for 27.8%; 22.2% and 11.1%, respectively Common cliniral symptoms of bacterial meningitis are infectious syndrome (100%), meningeal syndrome (100%) and disorders of consciousness (47.6%). Cliniral symptoms of viral en- cephalitis are common meningeal syndrome (80%), in- fectious syndrame (60%) and disorders of consiousness
Keywords: Meningoencaphalitis, clinical, paradiniral.
(20%). The percentage of patients with the infectious syn- drome and meningeal syndrome were similar in patients sufferring from tuberculous meningitis and parasitic meningitis that account for 75% and 33%, respectively The average value of the PCT is highest in patients with bacterial meningitis (11.79 ± 2.29ng/ml), and the lowest in patients with parasitic meningitis (0.20 ± 0.20ng/ml).
The average value of white blood cells (WBC) in the cere- brospinal fluid (CSF) is highest in patients with bacterial meningitis (1547 ± 3 cells/mm^), and the lowest in pa- tients with viral encephalitis (76 ± 8cells/mm^). The aver- age value of the concentration of protein in the CSF is highest in patients with tuberculous meningitis (2.95 ± 3.6g/l) and bacterial meningitis (2.06 ± 2.12g/l).
T R U Y i N N H l i M V I $ T N A M * s 6 3 ( 1 5 ) - 2 0 1 6 - 11