Hippokratia 2003, 7(4):177-181

H Tsangaropoulou-Stinga, F Kanakoudi-Tsakalidou, E Hatzipantelis, A Taparkou, V Tzimouli, J Kavaliotis, K Avramidou, A Karassavidou, X Dedoukou, N Manos

Abstract

Objective: Changes in the concentration of inflammatory cytokines in the cerebrospinal fluid (CSF) and serum of patients with bacterial meningitis (BM) have been the objective of several studies mainly with respect to their prognostic value. The aim of our study was: 1. To investigate the serial changes of IL-1?, TNFa, IL-6 and IL-8 in the CSF of children with BM during the first three days from the disease onset and 2. To correlate our findings with the disease complications and outcome. Methods: Thirty two children, hospitalised for BM during a 2 year and 4 month period, were studied. In 20 cases a causative agent was isolated (N. meningitides=9, H.influenzae=9, S. pneumoniae=2) while in 12 of them no pathogen was found. All patients were treated with ceftriaxone (100mg/kg/d IV for 7-10d) and dexamethasone (0,6mg/kg/d IV for 2d). The CSF and serum samples were obtained concomitantly on admission (1st), 12-24h later (2nd) and 52-72h after the 1st sample. Levels of IL-1?, ??F-a, IL-6 and IL-8 were assessed using the Quantikine Immunoassay Kit. Results: None of the cases was complicated by shock, none of the patients died and all were cured. 7/32 children presented with secondary fever and 5/32 with prolonged fever. In 4 out of these 5 patients subdural effusion was also present. The levels of all cytokines studied, were increased in the CSF and serum samples but they were significantly higher in the CSF. In the patients with prolonged fever (5) levels of IL-6 and especially of IL-8 in the CSF were persistently higher than those found in patients with secondary fever or early apyrexia, while in serum no difference was found. No correlation of cytokine levels and some other parameters studied (day of disease on admission, treatment prior to admission, causal agent of meningitis etc) was found.Conclusions: Prolonged fever with or without subdural effusion in patients with BM is related with persistence of high CSF levels of IL-6 and IL-8 for more than 3 days. This may be indicative of persistence of the inflammatory process elsewhere in the CNS and may need immunomodulatory therapy.

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