Elevated production of radical oxygen species by polymorphonuclear neutrophils in cerebrospinal fluid infection

Anne-Claire Lukaszewicz,Didier Payen,Valerie Faivre,Geraldine Gontier,Ingrid Ouanounou

doi:10.1186/2110-5820-2-10

Abstract

BackgroundCentral nervous system infection is a daily concern in neurointensive care; however, diagnosis remains difficult because classical criteria based on cerebrospinal fluid (CSF) analysis are difficult to interpret in post-trauma or neurosurgery patients after recent bleeding. A rapid, specific, sensitive test to diagnose CSF infection would help streamline therapeutic decisions in clinical practice and limit the risk of multiresistant bacteria. We hypothesized that polymorphonuclear neutrophil (PMN) phenotype and radical oxygen species (ROS) production in CSF may be specific to the presence of infection.MethodsThis study included 30 patients with suspected CSF infection with ventricular hemorrhage requiring external ventricular drainage, and 13 patients after trauma or surgery. Criteria for evaluating CSF infection included positive culture and > 100 leukocytes/mm3. Analysis of PMN phenotype was performed using flow cytometry (CD16, CD11b, and CD62L). ROS production was analyzed through luminometry (luminol).ResultsInfected CSF exhibited higher production of ROS compared with noninfected CSF. PMNs in CSF exhibited low CD16 and high annexin V expression, suggesting apoptosis.ConclusionsMeasurement of ROS production may discriminate infected from noninfected CSF. This simple test would be easy to employ in clinical practice to improve CSF infection management.

Highlights

Central nervous system infection is a daily concern in neurointensive care; diagnosis remains difficult because classical criteria based on cerebrospinal fluid (CSF) analysis are difficult to interpret in post-trauma or neurosurgery patients after recent bleeding
Global radical oxygen species (ROS) production in CSF from patients with suspected infection According to the protocol, CSF was sampled by external ventricular drainage (EVD) in response to fever (> 38°C)
We propose a rapid test for the diagnosis of CSF infection in the difficult context of postoperative or nosocomial meningitis

Summary

Introduction

Central nervous system infection is a daily concern in neurointensive care; diagnosis remains difficult because classical criteria based on cerebrospinal fluid (CSF) analysis are difficult to interpret in post-trauma or neurosurgery patients after recent bleeding. A rapid, specific, sensitive test to diagnose CSF infection would help streamline therapeutic decisions in clinical practice and limit the risk of multiresistant bacteria. Diagnosis of meningeal or intracranial infection remains difficult in post-trauma or neurosurgical patients for several reasons. Classical criteria based on cerebrospinal fluid (CSF) analysis, such as pleocytosis with a high proportion of polymorphonuclear neutrophils (PMNs), low glucose, and high protein levels, are difficult to interpret soon after bleeding or surgical procedures. Ventriculostomy catheterization, or external ventricular drainage (EVD), is an important and frequently used invasive procedure in neurosurgical and intensive care practice. High risk of infection has been associated with intraventricular hemorrhage and the duration that the catheter remains in situ [4]

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