Anti-interleukin-8 auto-antibodies in cerebrospinal fluid of children with purulent meningitis.

BACKGROUND: Cerebrospinal fluid (CSF) of patients with purulent meningitis contains a high concentration of interleukin (IL)-8. Recently, the presence of anti-IL-8 auto-antibodies was noted in blood and alveolar fluid. Therefore, measurement of the concentration of anti-IL-8 auto-antibodies was attempted in CSF of children with and without meningitis. METHODS AND RESULTS: We measured the concentration of anti-IL-8 auto-antibodies in CSF of children with purulent or aseptic meningitis and those without meningitis. The CSF obtained on admission showed a significantly higher concentration of anti-IL-8 IgG and IgM auto-antibodies in children with purulent meningitis, compared with those with aseptic meningitis or without meningitis. Among the three groups of children, the concentration of IL-8 was also significantly higher in CSF of children with purulent meningitis. CONCLUSION: Because the anti-IL-8 IgG auto-antibody binds to IL-8 and inhibits IL-8 interaction with specific receptors on neutrophils, the presence of anti-IL-8 auto-antibodies seems to provide a mechanism that limits the bioavailability of free IL-8 in CSF.

Cerebrospinal fluid levels of soluble CD14 in inflammatory and non-inflammatory diseases of the CNS: upregulation during bacterial infections and viral meningitis.

The CD14 antigen, an important cell surface molecule of monocytic cells, is involved in cellular activation: it binds lipopolysaccharide and other cellular lipid structures. Brain macrophages play a pivotal role during inflammatory reactions of the CNS parenchyma, ventricles and meninges. A soluble form of CD14 (sCD14) was measured in paired cerebrospinal fluid (CSF) and serum samples from 91 patients with different neurological diseases. Mean levels of circulating sCD14 in CSF in a control group of 22 patients with neurologic complaints but no neurological deficit on clinical examination were 0.19 +/- 0.06 (mean +/- SD) mg/l. The CSF/blood ratios of sCD14 was 49 +/- 16 x 10(-3), while those of albumin were 4.4 +/- 1.4 x 10(-3). These extremely high CSF/blood ratios of the sCD14 molecule compared to albumin indicate a local cerebral production. No significant changes in CSF sCD14 levels were found in patients with non-inflammatory neurological diseases (NID). In contrast, CSF sCD14 levels were markedly elevated during acute meningitis, but there was no direct correlation between sCD14 and monocyte count in the CSF. Thus, sCD14 could not originate in the CSF compartment from monocytes alone. The highest values for sCD14 were found in CSF during infections with various pathogens such as Staphylococcus aureus or Listeria monocytogenes. While sCD14 serum levels dramatically increased during acute bacterial meningitis, sCD14 ratios did not correlate with albumin ratios during the course of disease. Therefore, increased CSF sCD14 may originate from cerebral production by activated or infiltrated macrophages rather than passive diffusion from the blood, while elevated sCD14 serum levels resulted from enhanced local production. Increased CSF and serum sCD14 values were also observed in meningitis caused by viral infection. As in bacterial meningitis, sCD14 in CSF specimens did not correlate with the function of the blood/CSF barrier. Repeated lumbar punctures revealed a normalization of CSF sCD14 levels during clinical recovery. These results provide the first evidence for local production of sCD14 within the CNS. Our findings further indicate that sCD14 in CSF is a reliable marker for activation of macrophages within the CNS during inflammatory processes.

[Usefulness of reactive strips in the diagnosis of suppurative meningitis, at the patient's bedside]. / Utilidad de las tiras reactivas en el diagnóstico de las meningitis supuradas, a la cabecera del paciente.

The CSF from 68 children suspected of meningitis (20 meningitis, 48 normal) was analyzed with the customary laboratory techniques (cellularity, differential count, glucose, proteins and bacteriology) and with Combur 9 test strips (glucose, proteins and leukocytes-granulocytes) in order to evaluate the suitability of the latter for the rapid diagnosis of meningitis.

[CSF. changes in partially treated bacterial meningitis (author's transl)]. / Modificaciones del L.C.R. por tratamiento antibiótico parcial en meningitis purulentas

Review of 102 admissions of children (one month to seven years of age) with bacterial meningitis is presented. 46 of the patients (45%) had been treated previously with one or more antibiotics. Previous treatment made culture of CSF negative in a statistically significant (p less than 0.001) number of cases, mainly in meningococcal meningitis. There were no significant differences in the levels of CSF glucose, proteins and WBC's between both groups. A decrease of the percentage PMN/lymphocytes was found in the CSF of the partially treated group. In 7 out of 102 no more than two CSF pathological findings were present. In 5 or 7 CSF cultures were positive. In the other two there were pathological changes in CSF even with correct dosage of previous antibiotics. In 4 patients with positive cultures and little changes in CSF on admission, LP after 48 hours of correct treatment showed an increase in the alterations of CSF. This could mean that previous low dosage antibiotic treatment should not modify CSF findings enough not to make correct diagnosis.