Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Inflammatory response plays an important role in the pathogenesis of cerebral injury in bacterial meningitis. In this study, we evaluated the cytokine levels of interleukin 1-beta (IL1 beta), tumour necrosis factor alpha (TNF alpha) and interleukin 6 (IL6) in the cerebrospinal fluid (CSF), and determined their correlation with acute clinical complications and with changes in CSF biochemistry. Interleukin 6, TNF alpha and IL1 beta were present in 9/9, 3/9 and 4/9 patients, respectively. The CSFs with detectable TNF alpha or IL1 beta had higher levels of IL6 (p < 0.02), protein (NS) and lower glucose levels (p < 0.02), compared with those in which TNF alpha and IL1 beta were absent. Tumour necrosis factor alpha and IL1 beta levels also correlated with the presence of prolonged fever, fits, spasticity and death (logTNF alpha: r = 0.70, p < 0.05; logIL1 beta: r = 0.62, p = 0.08). The cytokine levels reflect the degree of inflammatory response and are positively correlated with the severity of acute clinical complications. Modulation of this inflammatory response in bacterial meningitis may improve its morbidity and mortality.
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PMID:Inflammatory response in bacterial meningitis: cytokine levels in the cerebrospinal fluid. 759 38

Beta 2-microglobulin (beta 2m) determination in CSF of 72 neonates who underwent a spinal tap as part of a sepsis or meningo-encephalitis workup was performed to evaluate the usefulness of this test in the diagnosis of CNS infections. Beta 2m was measured by enzyme immunoassay. Sixty neonates had sterile culture and normal neurological status at discharge. Twelve infants had CNS infections: 8 bacterial meningitis, 3 TORCH infections (T = toxoplasmosis, O = others, R = rubella, C = cytomegalovirus and H = herpes simplex) and 1 viral meningitis. Neonates with CNS infection exhibited significantly higher CSF beta 2m levels compared to neonates with sterile culture (6.24 +/- 2.66 vs 1.74 +/- 0.5 mg/l; P < 0.0001). CSF beta 2m levels did not correlate with the white cell count, total protein concentration or glucose level in CSF. When serum and CSF levels were measured simultaneously, the CSF beta 2m level was significantly higher than the corresponding serum level in patients with CNS infection (6.98 +/- 2.5 vs 3.2 +/- 0.25 mg/l; P < 0.01). Sensitivity, specificity, and predictive values were estimated for different cut-off points. The best operational diagnostic cut-off value was 2.25 mg/l. Receiver operating characteristic curve analysis showed an appropriate trade-off between specificity and sensitivity and indicated that CSF beta 2m was accurate in distinguishing between neonates with and without CNS infection. Conclusion. CSF beta 2m may be a useful ancillary tool in neonates when CNS infection is suspected.
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PMID:Cerebrospinal fluid beta 2-microglobulin in neonates with central nervous system infections. 760 83

We examined the measurement and the diagnostic value of cerebrospinal fluid interleukin-6 (CSF IL-6) in meningitis. The cytokine was measured by bioassay (B9 hybridoma cell line) and by immunoassay (in-house radioimmunoassay). We compared the diagnostic value of CSF IL-6 determination with that of other biochemical markers of meningitis. Although there was significant correlation between bioactive and immunoactive IL-6 (r = 0.724, P < 0.001), results were frequently different with biological/immunological ratios ranging from 0.2 to 24.3 (mean 4.6). Gel permeation chromatography suggested that the discrepancy in biological and immunological activities was not due to molecular heterogeneity, but may be explained by the presence of a synergistic factor. Interleukin-6 concentration was markedly elevated in CSF from most patients with bacterial meningitis compared to patients with viral meningitis and those without evidence of infection. However, low IL-6 levels by radioimmunoassay did not exclude bacterial meningitis (sensitivity 86%). CSF total protein and CSF glucose were significantly different between all three groups, but there was no significant difference in lactate concentration between virally infected and normal CSF, both of which had lower lactate concentrations than those in bacterial infection. CSF IL-6 measurement had greater sensitivity, specificity and predictive value than these other biochemical markers, and hence a rapid assay for IL-6 in CSF may contribute to the early diagnosis of bacterial infection.
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PMID:Cerebrospinal fluid interleukin-6 and its diagnostic value in the investigation of meningitis. 763 33

A previously reported statistical model based on a combination of four parameters (total polymorphonuclear cell count in cerebrospinal fluid (CSF), CSF/blood glucose ratio, age and month of onset) appeared effective in differentiating acute viral meningitis (AVM) from acute bacterial meningitis (ABM). The objectives of this study were to validate this model on a large independent sample of patients with acute meningitis and to build and validate a new model based on this sample. Of 500 consecutive cases of community-acquired meningitis reviewed retrospectively, 115 were ABM, 283 were AVM and 102 were of uncertain etiology. For each of the ABM and AVM cases, the probability of ABM versus AVM (pABM) was calculated for both models. Sensitivity, specificity and predictive values as well as areas under the receiver operating characteristic (ROC) curves were calculated for both models. The original model proved an accurate and reliable diagnostic test. Its area under the ROC curve was 0.981. For pABM = 0.1, its negative and positive predictive values were 0.99 and 0.68, respectively. The new model retained four slightly different independent variables: CSF protein level, total CSF polymorphonuclear cell count, blood glucose level and leukocyte count. Its area under the ROC curve was 0.991 and, for pABM = 0.1, its negative and positive predictive values were 0.99 and 0.85, respectively. In conclusion, both models provide a valuable aid in differentiating AVM from ABM. They should be further evaluated in a prospective appraisal of their contribution to therapeutic decision making.
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PMID:Multivariate approach to differential diagnosis of acute meningitis. 874 Aug 64

The penetration of amikacin into the cerebrospinal fluid (CSF) was studied with 16 children (mean age, 1 year and 9 months; range, 4 months to 8 years) with community-acquired bacterial meningitis. Amikacin was given intravenously at a dose of 7.5 mg/kg of body weight twice daily. CSF was collected on day 1, at the expected peak concentration of amikacin in CSF. The mean (standard deviation) concentration of amikacin in CSF was 1.65 (1.6) mg/liter. Concentrations of amikacin in CSF correlated significantly with CSF glucose levels on admission. The mean concentrations of amikacin in CSF were 2.9, 1.1, and 0.20 mg/liter in patients with CSF glucose levels of < 1, 1 to 2, and > 2 mmol/liter, respectively. Thus, amikacin penetrates the blood-brain barrier substantially in children with bacterial meningitis and achieves particularly high concentrations when CSF glucose level is < 1 mmol/liter on admission.
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PMID:Cerebrospinal fluid penetration of amikacin in children with community-acquired bacterial meningitis. 769 18

Laboratory examination of cerebrospinal fluid (CSF) is not available in many parts of the world, and without knowledge of CSF glucose, protein, and cells, a diagnosis of meningitis may be missed. Testing CSF with urine reagent strips that measure glucose and protein has given variable results. We tested CSF samples from 234 children with suspected meningitis for glucose, protein, and leucocytes with Combur9 reagent strips. The results were compared with those obtained from the laboratory and also interpreted as indicating bacterial or viral meningitis. There was good agreement between the strip and laboratory method of estimating CSF glucose, protein, and leucocytes. All but 4 of the cases of meningitis were correctly identified by the strip method (sensitivity 97%). 2 (2.9%) of 69 cases of bacterial meningitis were judged by an independent observer to be viral, and 2 (3.3%) of 60 cases of viral meningitis as normal. No normal CSF was diagnosed as meningitis (specificity 100%). The results indicate that Combur9 reagent strips can distinguish normal from infected CSF and are of value in the diagnosis of meningitis.
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PMID:Rapid diagnosis of bacterial meningitis with reagent strips. 888 91

Neisseria meningitidis is the etiologic agent of epidemic bacterial meningitis. Lipooligosaccharide (LOS) is a principal virulence factor associated with the organism, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis of LOS has demonstrated that there is considerable microheterogeneity in the molecule. To begin our understanding of the nature of this heterogeneity, we identified a Tn916-generated LOS mutant of N. meningitidis NMB (serotype L3, monoclonal antibodies 3F11+, 6B4+, and 4C4-) that was designated NMB-SS3 (monoclonal antibodies 3F11-, 6B4-, and 4C4+). The transposon insertion was localized to the amino terminus of the functional copy of the UDP-Glc 4-epimerase gene (galE). UDP-Glc 4-epimerase (EC 5.1.3.2) activity was present in N. meningitidis NMB but not in NMB-SS3, indicating that the Tn916 insertion had abolished this activity. Mass spectrometric analysis of the LOS from strain NMB revealed multiple species of LOS, which is consistent with extensive microheterogeneity. While the most predominant structure was consistent with a terminal lacto-N-neotetrose structure found in other strains of N. meningitidis, Gal beta 1-->4GlcNAc beta 1-->3Gal beta 1-->4Glc-->(GlcNAc)-->Hep2PEA-->KDO2 (where Hep is heptose, PEA is phosphoethanolamine, and KDO is 2-keto-3-deoxymannooctulosonic acid), structures containing repetitive hexoses which are not precursors of this structure were also identified. Compositional analysis of LOS from strain NMB-SS3 revealed that there were no galactoses present in the structure. Mass spectrometric analysis of O-deacylated LOS revealed the presence of multiple species, with the predominant LOS species in this mutant strain formed by the Hex-->(HexNAc)-->Hep2PEA-->KDO2 (where Hex is hexose and HexNAc is N-acetylhexosamine) structure. However, LOS structures with repetitive hexoses, e.g., Hexn-->(HexNAc)-->Hep2PEA-->KDO2 (n = 2, 3, or 4), emanating from one or both heptoses were also identified. Since this mutant cannot synthesize UDP-Gal, these structures must repetitive glucoses. These data suggest that NMB has a glycosyltransferase capable of polymerizing glucose moieties as an alternative biosynthetic pathway to the wild-type lacto-N-neotetrose structure.
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PMID:Microheterogeneity of Neisseria lipooligosaccharide: analysis of a UDP-glucose 4-epimerase mutant of Neisseria meningitidis NMB. 779 63

Clinical patterns of tuberculous meningitis have been analyzed for 32 admissions to the bacterial meningitis department of the 2nd Moscow Infection Hospital in 1983-1991. Early diagnosis of tuberculous meningitis caused great difficulties because of rare cases of tuberculous history, atypical symptoms (an acute onset, in particular), an obscure meningeal syndrome, rare neurological symptoms, atypical liquor characteristics (frequent neutrophil pleocytosis, a small protein rise, normal glucose). Secondary bacterial meningitides presented most serious difficulties for differential diagnosis. So did cerebral abscesses and viral meningitis. Antituberculous therapy should be started at first sings of tuberculous nature of meningitis as the disease outcomes are determined to a large extent by early administration of proper treatment.
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PMID:[The characteristics of the present-day clinical course of tuberculous meningitis]. 790 20

Despite numerous epidemiological analyses of bacterial meningitis there is very little pathological data concerning the acute glial and neuronal responses to the disease. We have developed a safe, easily used rat model for Haemophilus influenzae type b meningitis. We measured cerebral blood flow, glucose utilisation and second messenger activity in this model, and carried out parallel light and ultrastructural analysis of glial and neuronal responses. Only protein kinase C activity was changed from control values. We obtained evidence for massive astrocytic swelling and neuronal degeneration. We posit that cytotoxic mechanisms may contribute to the pathology of meningitis.
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PMID:Diffuse astrocytic swelling and increased second messenger activity following acute Haemophilus influenzae meningitis--evidence from a rat model. 797 17

Viral meningitis are the most frequent cause of clear cerebrospinal fluid (CSF) meningitis and are usually benign. The viral nature is suggested by clinical arguments (context, associated manifestations) and particularly the analysis of CSF, typically lymphocytic. However, problems of CSF interpretation may occur during the polymorphonuclear reaction at the beginning of such meningitis and after elevated protein or low glucose concentration. The main differential diagnosis are: partially treated bacterial meningitis, the beginning of meningococcal meningitis, listeriosis or tuberculous meningitis which need and urgent and specific treatment. The most common agents are the enteroviruses. The etiology can only be detected through careful virological investigations. These studies may be useful in outbreaks or in epidemiological studies.
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PMID:[Acute viral meningitis]. 798 16


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