Cerebrospinal Fluid TNF-α, IL-6, and IL-8 in Children With Bacterial Meningitis

OBJECTIVE: We evaluated the levels of cerebrospinal fluid concentrations of tumor necrosis factor-alpha, interleukin-6, and interleukin-8 in bacterial meningitis in children. METHODS: The study included children up to 14 years of age admitted to a pediatric ward with fever, headache, vomiting, and seizures. The diagnosis of bacterial meningitis was based on clinical features: physical examination, blood and cerebrospinal fluid cytochemical findings, Gram stain, and bacterial culture. The cerebrospinal fluid levels of tumor necrosis factor-a, interleukin-6, and interleukin-8 were measured in 57 children with bacterial meningitis, 15 with viral meningitis, and 15 controls by enzymelinked immunosorbent assay methods. RESULTS: The mean concentrations of cerebrospinal fluid, tumor necrosis factor-alpha, interleukin-6, and interleukin-8 were 1108 +/- 183, 652 +/- 287, and 442 +/- 120 pg/mL, respectively, in children with bacterial meningitis and were significantly increased in those in the viral meningitis group (tumor necrosis factor-alpha: 711 +/- 105, IL-6 : 272 +/- 161, IL-8: 175 +/- 62 pg/mL; P < 0.001) or control (390 +/- 37, 59 +/- 17,19 +/- 13 pg/mL, respectively, P < 0.001). At optimum cutoff level based on the receiver operating characteristic curve, cerebrospinal fluid cytokines (tumor necrosis factor-alpha, interleukin-6, and interleukin-8) showed sensitivity and specificity of 100% for the diagnosis of bacterial meningitis. For differentiation of bacterial from viral meningitis, cerebrospinal fluid level of tumor necrosis factor-alpha, IL-6, and IL-8 showed sensitivity and specificity of 94.7% and 86.7%, 80.7% and 53.3%, and 89.5% and 86.7%, respectively. CONCLUSION: The increased concentration of cerebrospinal fluid tumor necrosis factor-alpha, interleukin-6, and interleukin-8 in children with meningitis suggests a role in the pathogenesis of bacterial meningitis and these levels might prove to be useful in children whose diagnosis is in question.