[Diagnosis of meningitis with reagent strips] / Diagnóstico das meningites através de fitas reagentes.

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.

[Active and passive immunization against acute viral hepatitis] / Imunização ativa e passiva em hepatites agudas virais.

OBJECTIVE: The authors present the main indications related to the use of passive and active immunization against acute viral hepatitis, specially the composition, characteristics and current aspects of hepatitis A vaccination. Measures for hepatitis B prevention are also discussed. METHODS: The most recent and relevant articles published about the subject were selected and the special aspects of the immunological response, through different pediatric ages, are shown. RESULTS: The text analyzes the general measures for prevention of hepatitis A using the two inactivated vaccines, and also summarizes the indications and composition of the hepatitis B vaccines. CONCLUSIONS: Literature provides the guidelines for active and passive immunization against viral hepatitis and the present review is an update in the subject.