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2000, Cilt 30, Sayı 3-4, Sayfa(lar) 142-152
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TNF- α, IL-1Β, sICAM-1, Levels in Plasma and Cerebrospinal Fluid in Children with Bacterial and Viral Meningitis
Filiz Odabaşı1, Yıldız Camcıoğlu1, Necla Akçakaya1, Haluk Çokuğraş1, Feza Otağ2
1İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi, Çocuk Hastalıkları Anabilim Dalı, İnfeksiyon Hastalıkları, Klinik İmmünoloji ve Allerji Bilim Dalı, İstanbul
2İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi Kan Merkezi, İstanbul
Keywords: Bacterial meningitis, Viral meningitis, Cerebrospinal fluid, Tumor Necrosis Factor-alfa, Interleukin 1-beta, Soluble Intercellular Adhesion Molecul-1

Aim: To measure concentrations of soluble intercellular adhesion molecul-1(sICAM-1) in blood and CSF during meningeal inflamation, to find the relatioship between these adhesion molecules and TNF- α, IL-1Β levels in blood and CSF, and acute phase reactants (leukocytosis, neutrophilia, CRP, ESR); to determine whether changes of these parameters-duration of response time to therapy or how to response to therapy-show any parallel relationship with a constant parameter that can help diagnosis or differetial diagnosis.

Methods: 29 children aged between 2 months-12 years of age, diagnosed as bacterial (group A) and viral meningitis (group B) and as a control group, 17 children who had febrile or afebril convulsions were included the study. The survey had been conducted between June 1994-January 1996. Children were excluded who has been prescribed antibiotic and corticosteroid 3 days prior to admission. On admission, venous blood samples were taken from both patient and control groups, for measurement of CRP, ESR, WBC, blood smear, complete blood counts and glucose levels. Measurement of TNF- α, IL-1Β and sICAM-1 levels were performed with ELISA. Mann-Whitney and Kruskal Wallis tests were performed for statistical analysis.

Results: In acute bacterial and viral meningitis, there's no correlation between plasma sICAM-1 levels and acute phase reactants. In acute bacterial meningitis plasma sICAM-1 level show parallelity with plasma TNF- α level. There's negative correlation between CSF glucose level and CSF sICAM-1 level. As serum and CSF sICAM-1 levels show ongoing meningeal inflammation more sensitively than cytokines, in a prognostic evaluation sICAM-1 can be used alone. During meningitis, sICAM-1 that produced locally in CNS shows cellular activation in subarachnoid area, cytokines release and degree of inflammation. In viral meningitis, sICAM-1 level measurement in CSF is found much more valuble in diagnosis than cytokine measurement. As a results in differential diagnosis of viral and bacterial meningitis, CSF sICAM-1 level can be used as a more sensitive parameter than cytokine levels.


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