ABSTRACT
Over the past decade, much has changed on the landscape of meningitis. The purpose of this study was to investigate the involvement of nitric oxide [NO] and tumor necrosis factor alpha [TNF-alpha] in the pathogenesis of childhood meningitis. We measured the concentration of NO[-][2] [a stable metabolite of NO] and TNF-alpha in serial samples of cerebrospinal fluid [CSF] from 21 children with septic and 18 with aseptic meningitis and 20 control patients without meningitis. Significantly higher CSF NO[2] concentrations were detected in those with bacterial meningitis than those with aseptic meningitis [27.6 +/- 26.8 versus 12.2 +/- 12.3 micro mol/L; P<0.001] or among non-meningitis subjects [13.2 +/- 24.2 micro mol/L; P<0.0001]. Clinical and laboratory improvement following administration of antibiotics and dexamethasone was associated with a fall in CSF [NO[-][2] to normal levels in these patients. The mean [ +/- SD] of concentration in septic meningitis was 148.74 +/- 338.77 pg/ml. There was significantly more TNF-alpha than aseptic meningitis [6.85 +/- 17.93 pg/ml; [P<0.,001] or non-meningitis [7.67 +/- 16.07 pg/ml; P<0.001]. We did not find a correlation between CSF nitrate/nitrite levels and TNF-alpha [r = 0.046]. Our findings indicate that NO and TNF- alpha [r = 0.046]. Our findings indicate that NO and TNF- alpha [r = 0.046]. Our findings indicate that NO and TNF- alpha production are enhanced in the CSF compartment of children with septic meningitis and support the hypothesis that both markers are involved in the pathophysiology of septic meningitis