Interferon-gamma inducing factor [IL-18], interferon-gamma and cystatin C levels of children with meningitis

The objective of this study was to measure the levels of interleukin [IL]-18, interferon [IFN]- gamma and cystatin C in the cerebrospinal fluid [CSF] of children with meningitis. The study was carried out on 30 patients [12 males and 18 females] admitted to in-patient pediatric department in El Minya fever hospital and EL-Minya University hospital, for evaluation and treatment from meningitis during the period from January 2004 to December 2004. Within the entire group of the study the most common signs of meningitis were included. Thirteen children had septic meningitis [positive CSF culture] and 17 children had aseptic meningitis [negative CSF culture and lymphomonocytic pleocytosis in CSF analysis]. Twenty children of matched age and sex, having normal CSF during evaluation for meningitis, served as a control group. All CSF samples were obtained under aseptic conditions. CSF samples were cultured, analyzed for glucose, protein and WBCs. Another part from CSF samples assayed were immediately frozen at-70°C unit cystatin C, IFN-gamma and IL-18 in CSF were assaved by using a two -site enzyme linked immunosorbent assayed for cystatin C, IL-18 and IFN-gamma. The results showed that septic meningitis group had significantly higher CSF WBCs and protein levels than in aseptic meningitis and control groups [P<0.005]. IL-18 was significantly higher in septic group, it was detected in 95% of children with septic meningitis and only in the CSF of 48% of aseptic meningitis group. In control subjects, 10% had detectable levels of IL-18 in the CSF. IFN-gamma was significantly higher in aseptic group, it was detected in 96% of aseptic meningitis and 35% of children with septic meningitis, while 21% was detected in CSF of control subjects. cystatin C was detected in 44% of children with septic and aseptic meningitis, compared with control children [P<0.001], While cystatin C was significantly decreased in septic and aseptic groups. No significant correlation was found between IL-18,IFN-Y and cystatin C levels and total leukocyte count in the CSF of children with meningitis. Our data suggest that IL18, IFN-gamma and cystatin C are significantly changed in the CSF of children with meningitis. IL18 had greatest elevations while cystatin C was significantly decreased in those children with septic meningitis. IFN-gamma had greatest elevation seen in those children with aseptic meningitis. So, cystatin C and IL18 could be considered as sensitive and specific parameters for detection of septic meningitis, while IFN-gamma could be considered as sensitive and specific parameter for detection of aseptic meningitis

Assessment of the use of circulating intercellular adhesion molecule-1 in the diagnosis of neonatal sepsis

Neonatal sepsis still remains a major cause of neonatal morbidity and mortality. In spite of remarkable advances in perinatal care, a major contributing factor is the lack of a rapid and accurate diagnostic tool. Circulating intercellular adhesion molecule-1 [cICAM-1] has been proposed as a promising c and idate. This study was designed to evaluate the use of cICAM-1 in the diagnosis of neonatal sepsis in the neonatal intensive care unit of Suez Canal University Hospital over the period of one year. The subjects included 67 neonates diagnosed as suffering from neonatal sepsis based on clinical picture in addition to a positive blood culture, cerebrospinal fluid analysis, chest X-ray or an elevated C-reactive protein [CRP] level; if the former three tests were negative. A control group comprised of 39 healthy neonates from the outpatient clinic was included. All neonates were subjected to a thorough history and physical examination, in addition to complete blood picture, CRP assay and cICAM-1 assay. The study period was from April 1999 to April 2000. The cICAM-1 level was significantly elevated in septic neonates, being even more so in preterm than full-term neonates. The sensitivity of cICAM-1 levels for diagnosis of sepsis at a cut-off point of 300 ng/ml was 89.6%, the specificity was 71.8%, the positive predictive value was 84.5%, the negative predictive value was 80%, and the accuracy 83%. The use of a higher cut-off point increased specificity while a lower cut-off point yielded a greater sensitivity. Combination of cICAM-1 and CRP levels for the diagnosis of sepsis yielded a higher sensitivity [95.5%]. In addition, cICAM-1 levels were related to outcome, with significantly higher levels being found in septic neonates who passed away than in those who survived. In conclusion, cICAM-1 estimation is an accurate test for the diagnosis of neonatal sepsis, and can also be used to predict outcome. The addition of CRP assessment improves sensitivity