Abacterial Meningitis Research Articles

Procalcitonin as a diagnostic marker in differentiating bacterial from abacterial meningitis

Background: Clinical differentiation of bacterial and abacterial meningitis is difficult even for experienced clinician, and current laboratory tests cannot distinguish between them accurately and rapidly. Therefore, we aimed to study the role of Procalcitonin (PCT) in differentiating bacterial from abacterial meningitis. Methods: Patients suspected of having meningitis admitted to Alexandria Fever Hospital were included in the study. CSF and blood samples were collected. CSF samples were subjected to microscopic examination, and culture. Blood samples were used to measure serum PCT level. Results: Out of the 75 examined cases; equal percentages (42.7%) were definitely diagnosed as bacterial and abacterial meningitis cases. Elevated PCT level was found in (81.3%) of bacterial meningitis versus (9.4%) of abacterial meningitis. PCT was the least method of diagnosis to be affected by preadmission antibiotic intake. PCT serum level had a sensitivity of 80.6%, a specificity of 91.3%, a negative predictive value of 93.5%, and a positive predictive value of 75.0%. Conclusion: Measurement of PCT blood level is a rapid, simple and specific test and may be recommended in the diagnosis of bacterial meningitis cases, especially those who received antibiotic therapy before hospitalization. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive

Is There Any Role for Innate Immunity in the Pathogenesis of Bacterial and Abacterial Meningitis?

To elucidate the role of innate immunity in the pathogenesis of meningitis, the effects of cerebrospinal fluid (CSF) and of sera from patients with bacterial and abacterial meningitis were studied on monocytes because of their resemblance in function with brain microglial cells. Monocytes were isolated from the mononuclear fraction of blood of healthy donors. They were incubated in growth medium single and in the presence of purified lipopolysaccharide or lipoteichoic acid of intact cells of Streptococcus pneumoniae and of samples of CSF and sera of patients. Samples were drawn from 10 patients with bacterial and 26 with abacterial meningitis. Concentrations of tumor necrosis factor α, interleukin (IL) 1β, IL-6, IL-10, IL-12, and interferon γ were estimated in cell supernatants by enzyme-linked immunosorbent assay and of procalcitonin by an immunochemiluminometric assay. It was found that the addition of CSF from patients with bacterial meningitis induced higher concentrations of IL-1β, IL-6, IL-10, IL-12, and procalcitonin than controls and than the addition of CSF from patients with abacterial meningitis. Intact cells of S. pneumoniae failed to elicit similar responses to CSF of patients. The presence of CSF from patients with abacterial meningitis induced higher levels of interferon γ and IL-6 than controls. It is concluded that cells of the innate immunity play a considerable role in the pathogenesis of meningitis. CSF triggering elicits cytokine responses that are higher in bacterial than abacterial meningitis; IL-1β, IL-6, IL-10, and procalcitonin are important mediators in bacterial meningitis and IL-6 and interferon γ in abacterial meningitis.

Serum procalcitonin levels in bacterial and abacterial meningitis

To test the hypothesis that serum procalcitonin (PCT) levels are elevated in patients with bacterial meningitis and remain within normal limits in patients with abacterial meningitis. Prospective case series. Tertiary care center. A total of 30 patients (13 men and 17 women) with a mean age of 52 yrs, having acute bacterial (n = 16) or abacterial (n = 14) meningitis. Blood and cerebrospinal fluid samples. Patients with abacterial meningitis were younger and had a shorter hospital stay. Of 16 patients with bacterial meningitis, 14 were in a septic condition at admission, but only 5 of 14 patients with abacterial meningitis were in a septic condition at admission. At discharge, 12 patients were without symptoms, 9 patients were moderately disabled, and 9 were severely disabled. No patient died. At admission, PCT, C-reactive protein, white blood cell and cerebrospinal fluid leukocyte counts, and cerebrospinal fluid protein and lactate levels were higher and the serum/cerebrospinal fluid glucose quotient was lower in patients with bacterial meningitis as compared with those with abacterial meningitis (p < .001). PCT was the variable with the highest specificity for bacterial infections (100%), but there were false-negative findings in five patients with bacterial meningitis (a sensitivity of 69%). Persistently elevated or increasing PCT levels after 2 days were associated with an unfavorable clinical course. Our results indicate that PCT is a useful additional variable for distinguishing bacterial from abacterial meningitis. In patients with abacterial meningitis, PCT levels do not increase even in cases of viral sepsis. Elevated PCT levels indicate a bacterial origin with high specificity, but false-negative results can occur.

Chemokines in the Cerebrospinal Fluid of Patients with Meningitis

Meningitis is accompanied by a differential immigration of leukocytes into the subarachnoid space. Since the mechanisms regulating leukocyte invasion are still incompletely understood, we studied the release of the neutrophil-attracting α-chemokines IL-8 and GRO-α and the mononuclear cell-attracting β-chemokines MCP-1, MIP-1α, and RANTES during meningitis. In 48 paired CSF and serum samples from patients hospitalized for meningitic symptoms, high levels of IL-8, GRO-α, and MCP-1 were detected in the CSF during bacterial and abacterial meningitis. Elevated chemokine levels were not found in the blood serum samples taken in parallel. The release of MIP-1α or RANTES was below detection limits. The IL-8 and GRO-α levels significantly correlated with the number of immigrated granulocytes in the CSF of patients with bacterial meningitis. A similar correlation was found when MCP-1 levels and the mononuclear cell count were analyzed in abacterial meningitis. These findings suggest that the local production of the α-chemokines IL-8 and GRO-α and of the β-chemokine MCP-1 represents the major chemoattractant stimulus for the differential recruitment of leukocytes into the subarachnoid space during meningitis.

Das Kawasaki-Syndrom bei Säuglingen im ersten Lebenshalbjahr

Diagnosis in Kawasaki disease usually is made on the so called main symptoms and on laboratory findings. The analysis of three cases in the first six months of life demonstrated that the typical symptoms concerning the mucosa and the lymphatic nodes are rare in this age group, whereas drug resistant fever and polymorphic exanthema was present in all patients. Besides that accessory symptoms like abacterial meningitis and pathologic urine analysis seemed to be frequent signs. Laboratory findings such as pathologic blood sedimentation rate, elevated CRP and thrombocytosis on the other hand were helpful in making the diagnosis.

Acid phosphatase activity of cerebrospinal fluid cells in bacterial and abacterial meningitis.

Acid phosphatase staining is performed on cerebrospinal fluid cells of 365 samples from 105 patients with various types of meningitis. This enzyme activity is strongly positive in the early samples of bacterial meningitis, as far as the patients had not received a pretreatment with antibiotics for more than 24 h. It allows monitoring the response to therapy in subsequent samples. Acid phosphatase activity is positive in 2 cases of cryptococcus meningitis. It is negative in all cases of aseptic and Mycoplasma pneumoniae meningitis. The results in herpes encephalitis are variable, depending on the clinical state and the degree of brain destruction. Acid phosphatase staining is a useful and rapid cytological technique for determination of the nature of the meningitis and for monitoring the therapeutical response.

Diagnostische Bedeutung der Lactatbestimmung im Liquor bei Meningitis

White-cell count and differential blood count, total protein, lactate dehydrogenase activity (E.C. 1.1.1.27) and lactate concentration were determined in 496 CSF samples, obtained by lumbar puncture. Lactate was measured with a new enzymatic test. Reference values were determined for lactate and lactate dehydrogenase (90% limits: 1.2-2.1 mmol/l and 6-26 U/l, respectively). Lactate content proved to be best in the differential diagnosis between acute bacterial and abacterial meningitis: concentrations of 3.5 mmol/ml and above were found exclusively in bacterial meningitis. As for other diseases, markedly increased lactate concentrations were measured only in patients with brain tumour or cerebrovascular disease (up to 9.3 mmol/l). Determination of lactate concentration alone would have led to a misdiagnosis of acute bacterial meningitis in 3% of cases. If the CSF contains 3.5 mmol/l lactate or more and the leucocyte cell count is above 800/microliter, brain tumour or cerebrovascular disease can be practically excluded and the diagnosis of bacterial meningitis made with a high degree of reliability.

Echovirus 30 epidemic (author's transl)

Echovirus 30 was the cause of abacterial meningitis and pharyngitis in 22 cases in the Ludwigshafen on Rhine area in summer 1976 and in a further 26 cases in various regions of the German Federal Republic. In 11 children echotype-30-virus could be isolated from the CSF. In 47 children the diagnosis was established by a rise of neutralising antibodies. Positive virus isolation from the CSF was only possible during the first two days of the illness using rhabdomyosarcoma cell tissue cultures. These were particularly sensitive to the echovirus 30 subtype found.

Hydrocephalus due to prenatal infection with the lymphocytic choriomeningitis virus.

The results are presented of serological examinations in a total of 4235 subjects including blood donors (341 persons), pregnant women (1784), newborns (833), patients with malignant tumours (248), patients with influenza-like diseases (548), patients with abacterial meningitis (295), infants under one year with hydrocephalus (40), infants under two years with other nervous system diseases (110), mothers of seropositive children with hydrocephalus (12) and mothers of seronegative children with hydrocephalus (24). The investigations revealed 16 cases of serologically confirmed prenatal lymphocytic choriomeningitis virus infection. Immunofluorescent antibody to this virus was detected in the children in most cases at high titers and in their mothers at moderate and low titers. In 14 children hydrocephalus was manifest, one child was suffering from infantile cerebral palsy, and one child from congenital right side blepharoptosis. Foci of chorioretinal degeneration were found in 14 patients. During pregnancy six mothers had an influenza-like illness; the other ten mothers denied any disease associated with fever.