The Diagnostic Value of CSF Tumor Necrosis Factor-alpha for Early Diagnosis of Bacterial Meningitis

ABSTRACT

PURPOSE: During the course of bacterial meningitis, TNF-alpha produced by macrophages and monocytes in response to LPS and other inflammatory and immune stimulation, is now recognized as a primary mediator in the pathogenesis of infection, injury and inflammation and in the process of host defence. TNF-alpha was increased vascular permeability by inducing morphologic and structural changes of endothelial cells by a direct toxic effect. The authers observed the concentration of CSF TNF-alpha, which was useful or not to differentiate bacterial meningitis from viral meningitis. METHODS: In 57 children with meningitis (10 bacterial meningitis, 47 viral meningitis) were studied, at Ewha Womans University Hospital from Jan. 1995 to Oct. 1995. In the time of diagnosis, chemistry, smear, culture, latex agglutination test, TNF-alpha of CSF were checked. In bacterial meningitis, Follow up spinal tapping was performed 48 hours, 1 week after treatement, in viral meningitis, follow up was performed 2 to 7 days after treatement. RESULTS: The positive rate of CSF TNF-alpha and mean concentration of CSF TNF-alpha were significantly different between two groups (bacterial meningitis 90% (9/10), 1026 +/- 390.1pg/mL vs. viral meningitis 6.3% (3/47), 12.6 +/- 61.9pg/mL) (P<0.01). Positive rate of the concentration of CSF TNF-alpha in the group of bacterial meningitis was changed 90% at pretreatement period, 80% at 48 hours after treatement, 10% at 7days after treatement. Changing of positive rate by the diagnositic method, the positive rate of culture of CSF was 10%, gram smear was 40%, latex agglutination was 50% at 48 hours after treatement. CONCLUSION: The concentration of CSF TNF-alpha was rapid and sensitive method of differentiation between bacterial meningitis and viral meningitis, which was reduced the use of excessive antivbiotics.