Cortisol kinetics in cerebrospinal fluid during bacterial meningitis

Bacterial meningitis (BM) remains an infectious disease with a significant morbidity and mortality. The aim of this study was to describe the kinetics of cerebrospinal fluid (CSF) cortisol levels during BM and to assess its relationship to disease severity and etiology. A total of 55 patients with BM were enrolled in the study. Elevated CSF cortisol upon admission and its rapid decrease after starting therapy were associated with increased BM severity as assessed by the Acute Physiology and Chronic Health Evaluation II score, the Sequential Organ Failure Assessment score, Glasgow Coma Scale score and the Glasgow Outcome Scale score. The comparison of CSF cortisol according to BM etiology revealed a trend toward higher concentrations in meningitis caused by Streptococcus pneumoniae compared to Neisseria meningitidis. Our results demonstrate that the initially elevated CSF cortisol concentrations decrease rapidly after administration of BM therapy (i.e. antibiotics and dexamethasone). Moreover, this rapid reduction of CSF cortisol was found in patients with high severity scores. (C) 2011 Elsevier Ltd. All rights reserved.