Bacterial meningitis is a life-threatening disease for all ages, so early appropriate treatment is essential. Today there is no such a marker that differentiate bacterial versus viral meningitis to decide treatment.
Objective: The study was undertaken to investigate the value of CSF levels of tumor necrosis factor-alpha (TNF-a) and interleukin-6 (IL-6) in the differential diagnosis of acute bacterial and viral meningitis.
Methods: From July 1999 to April 2000, we examined CSF samples taken on admission from 20 children with acute bacterial, 20 children with viral meningitis and 20 nonmeningitis individuals as a control samples. TNF-a and IL-6 levels were measured by competitive enzyme immunoassay. In relation to TNF-a and IL-6 levels: CSF inflammation parameters (cell count and type, protein and glucose levels, CSF/blood glucose ratio), causative agents, fever, recovery from meningeal symptoms, complications and sequelae were investigated.
Results: In acute bacterial meningitis TNF-a was determined in 90% of the patients,however in viral meningitis it was under detection level. IL-6 was determined in 85% of bacterial meningitis patients and 20% of viral meningitis cases. Both were below detection level in the control group. In bacterial meningitis diagnosis sensitivity of TNF-a in CSF was 90% and specificity was 100% whereas for IL-6 the values were 80% and 100% respectively. In differential diagnosis of viral and bacterial meningitis sensitivity of TNF-a was 90% and IL-6 was 80%. Between CSF TNF-a and IL-6 levels a very important relationship was observed. In bacterial meningitis both cytokines were found to be increased.
Conclusions: In bacterial meningitis diagnosis and differential diagnosis of bacterial and viral meningitis TNF-a levels were more sensitive than IL-6 and measurement in CSF of this cytokine for routine analyses seems to be usefull.