Spinal Fluid Fingerprint Distinguishes Brain Infections from Diseases

Cytokine profiling has been shown to distinguish patients with infections of the brain from other diseases and may become a valuable diagnostic tool, particularly in infants and young children.

Current laboratory testing of cerebrospinal fluid (CSF) does not consistently discriminate between different central nervous system (CNS) disease states. The ability to rapidly distinguish CNS infections from other brain and spinal cord disorders that share a similar clinical presentation is an urgent diagnostic requirement. New approaches focusing on aspects of disease biology, such as immune response profiles that can have stimulus-specific attributes have been suggested.

In this regard, investigators at Thomas Jefferson University (Philadelphia, PA, USA) undertook a preliminary proof-of-concept study using multiplex ELISA to measure CSF cytokine levels in various CNS disorders (infections, autoimmune/demyelinating diseases, lymphomas, and gliomas) to determine the potential utility of cytokine patterns in differentiating CNS infections from other CNS diseases.

In a retrospective analysis, the investigators evaluated samples collected from 43 patients who had received spinal taps during their hospital stays. CSF samples were examined for the presence of 41 different cytokines.

Statistical analysis revealed that patients with confirmed infection of the central nervous system had a different cytokine fingerprint from those confirmed as having tumors or autoimmune disease. Furthermore, within the cohort of patients having central nervous system infections, the CSF cytokine fingerprint was different in cases of viral infection compared to those with non-viral pathogens, such as bacteria or fungi.

“We have many tests for making diagnoses, but the ones that conclusively indicate infection can often take more time than we would like, especially in cases of childhood meningitis or encephalitis,” said senior author Dr. Mark Curtis, associate professor of pathology, anatomy, and cell biology at Thomas Jefferson University. “Once confirmed with additional research, our test could provide a first, rapid and less invasive way to look at what is happening in the brain and guide treatment or further testing.”

“Infants and young children have an especially high risk of meningitis and encephalitis and the related, often serious sequelae,” said Dr. Curtis. “Being able to rapidly identify a central nervous system disorder as infectious can be crucial in rapid response. In addition, the test could distinguish viral from non-viral infections, a distinction that could spare a child with a viral infection from an unnecessary course of antibiotics, and tailor the care toward antiviral and supportive measures as needed. Moving forward, our goal is to formally validate our findings with a larger sample size that includes both adults and children for future use in the clinical arena.”

Cytokine profiling of CSF for disease detection was described in the October 31, 2018, online edition of the journal PLOS ONE.

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