CSF Cytokine Characteristics Defined from Children with Meningitis

Enteroviral meningitis (EVM) are the most common etiological agent for viral encephalitis, and are predominantly reported among children and always present as a milder clinical illness than other infectious causes which only need supportive therapy.

However, bacterial meningitis (BM) is still associated with a high morbidity and mortality rate. Appropriate antibiotics treatment is essential to optimize outcomes. Cytokines are regarded as having important roles in meningeal inflammation in patients with central nervous system (CNS) infection.

Clinical scientists at the Zhejiang University School of Medicine (Hangzhou, China) carried a retrospective study and collected cerebrospinal fluid CSF and/or blood specimens for microbiological culture, viruses, and cytokine detection. Patients were categorized into three groups: EVM group: Patients with EVM were confirmed by the presence of pleocytosis and detection of enteroviral nucleic acid detection in CSF using polymerase chain reaction (PCR); BM group: Patients with bacterial meningitis who were diagnosed as having significant CSF white blood cell counts; Control group: children with febrile seizures who underwent lumbar puncture and had normal CSF.

CSF specimens and blood samples were taken for microbiological culture. Samples were injected into children's blood culture bottles (BACTEC FX400, Becton, Dickinson and Company, Franklin Lakes, NJ, USA) for enrichment culture. MALDI‐TOF (BRUKER, Billerica, MA, USA) was used for bacterial identification and VITEK 2 compact (bioMérieux, Marcy-l'Étoile, France) for bacterial drug sensitivity. Serum and CSF concentration of cytokines interleukin (IL)‐2, IL‐6, IL‐10, tumor necrosis factor (TNF), and interferon (IFN)‐γ were quantitatively determined by the CBA kit–BD CBA Human Th1/Th2 Cytokine Kit II (BD Biosciences, San Jose, CA, USA). The detection of EVs was performed by using commercial one‐step real‐time RT‐PCR assay kit.

The scientists reported that 43 patients were confirmed with meningitis, 27 patients with EVM, and 16 with BM. Children with EVM were older compared with BM and control group. Serum IL‐6 and serum IL‐10 were lower in EVM group than BM and control group. IL‐6, IL‐10, and IFN‐γ levels showed obviously increase in CSF in EVM group, while only IL‐6 increased in CSF in BM group. CSF concentrations of cytokines IL‐6, IL‐10, TNF, and IFN‐γ in children with EVM and BM were both higher than control group, but compared EVM group to BM group, CSF IL‐2, TNF, and IFN‐γ showed no difference between two groups.

The authors concluded that CSF cytokines elevated in both virus and bacterial meningitis, while serum elevation only occurred in bacterial infection. However, they could not distinguish enteroviral meningitis from bacterial meningitis with the parameters of CSF cytokines IL‐2, IL‐6, IL‐10, TNF, and IFN‐γ. The study was published on January 8, 2020 in the Journal of Clinical Laboratory Analysis.

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Zhejiang University School of Medicine
Becton, Dickinson and Company
BRUKER
bioMérieux
BD Biosciences