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Tumour necrosis factor-alpha in infectious meningitis
1Department of Paediatrics, University Children's Hospital, Zurich, Switzerland.
Abstract:
During a one year period tumour necrosis factor-alpha (TNF-alpha) was prospectively determined in the cerebrospinal fluid of 49 patients with infectious meningitis. TNF-alpha was found in the cerebrospinal fluid of 15 of 18 patients with bacterial meningitis. In 11 patients who had cerebrospinal fluid positive for TNF-alpha it was detected in only one serum (in low concentration). There was no significant correlation between the concentration of TNF-alpha in cerebrospinal fluid and the patient's age, duration of illness and fever, body temperature, and serum C reactive protein. However, cerebrospinal fluid protein concentrations of greater than or equal to 2 g/l and leucocyte values of greater than or equal to 2.5 X 10(9)/l were more often associated with high TNF-alpha concentrations (greater than or equal to 500 pg/ml). In contrast with bacterial meningitis, none of the 31 samples of cerebrospinal fluid from patients with viral meningitis was positive for TNF-alpha. Thus this investigation supports the conclusion, drawn from animal studies on TNF-alpha in the cerebrospinal fluid, that the presence of TNF-alpha is indicative of bacterial meningitis. Absence of TNF-alpha cerebrospinal fluid, however, was found here not to exclude a bacterial aetiology of the infection.
Insights
Tumor necrosis factor-alpha (TNF-alpha) in cerebrospinal fluid is a strong indicator of bacterial meningitis. However, its absence does not rule out bacterial infection, highlighting the need for continued diagnostic evaluation.
Area of Science:
- Neuroscience
- Immunology
- Infectious Diseases
Background:
- Meningitis, an inflammation of the membranes surrounding the brain and spinal cord, can be caused by bacterial or viral pathogens.
- Tumor necrosis factor-alpha (TNF-alpha) is a pro-inflammatory cytokine implicated in various inflammatory conditions.
Purpose of the Study:
- To prospectively investigate the presence and significance of TNF-alpha in the cerebrospinal fluid (CSF) of patients with infectious meningitis.
- To determine if CSF TNF-alpha levels can differentiate between bacterial and viral meningitis.
Main Methods:
- CSF samples from 49 patients with infectious meningitis were analyzed for TNF-alpha over a one-year period.
- TNF-alpha concentrations were correlated with clinical parameters including age, fever, illness duration, serum C-reactive protein, CSF protein, and CSF leucocyte counts.
Main Results:
- TNF-alpha was detected in the CSF of 15 out of 18 patients with bacterial meningitis.
- No CSF samples from 31 patients with viral meningitis were positive for TNF-alpha.
- Higher CSF protein (≥2 g/l) and leucocyte (≥2.5 X 10(9)/l) levels were associated with elevated CSF TNF-alpha concentrations (≥500 pg/ml).
Conclusions:
- The presence of TNF-alpha in CSF supports a diagnosis of bacterial meningitis, consistent with animal study findings.
- The absence of CSF TNF-alpha does not exclude bacterial meningitis, indicating its limitations as a sole diagnostic marker.