Myositis in Children with Meningococcal Disease: A Role for Tumour Necrosis Factor-α and Interleukin-8?

• Published in: The Journal of infection 2002-01, Vol.44 (1), p.17-21
• Main Authors: Carrol, E.D., Thomson, A.P.J., Mobbs, K.J., Fraser, W.D., Sills, J.A., Hart, C.A.
• Format: Article
• Language: English
• Subjects: Adolescent; Bacterial diseases; Bacterial diseases of the nervous system. Bacterial myositis; Biological and medical sciences; Biomarkers - blood; Child; Child, Preschool; Creatine Kinase - blood; Creatine Kinase, MB Form; Creatine Kinase, MM Form; Diseases of striated muscles. Neuromuscular diseases; Female; Human bacterial diseases; Humans; Infant; Infectious diseases; Interleukin-8 - blood; Isoenzymes - blood; Male; Medical sciences; Meningococcal Infections - complications; Meningococcal Infections - enzymology; Meningococcal Infections - metabolism; Myositis - enzymology; Myositis - metabolism; Myositis - microbiology; Neisseria meningitidis; Neurology; Prospective Studies; Severity of Illness Index; Tumor Necrosis Factor-alpha - metabolism
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1053/jinf.2001.0923

Objectives: Myalgia is under-recognized in meningococcal disease (MCD). In septic shock, myositis is thought to be mediated by pro-inflammatory cytokines such as tumour necrosis factor-α (TNF-α), interleukin-8 (IL-8) and interleukin-6 (IL-6) but this has never previously been studied in MCD. We aimed to demonstrate whether muscle damage mediated via TNF-α and other pro-inflammatory cytokines occurs in MCD, as estimated by creatine kinase skeletal muscle isoenzyme (CK-MM) and cardiac isoenzyme (CK-MB) concentrations. Methods: A total of 68 children, median age 2.7 years, with a diagnosis of MCD were prospectively studied. Severity of disease was measured using the Glasgow Meningococcal Septicaemia Prognostic Score (GMSPS). Severe disease was defined as a GMSPS of ≥8. TNF-α, IL-8, IL-6 and IL-1Ra concentrations were determined on samples taken on admission. Results: CK-MM correlated significantly with TNF-α, IL-8 and GMSPS. There was no significant correlation between CK-MB and TNF-α or IL-6, but CK-MB correlated with GMSPS and IL-8. Fifty-six percent of children with MCD had evidence of muscle damage as manifested by elevated CK-MM. Conclusions: TNF-α and IL-8 may be potential mediators in the pathophysiology of skeletal muscle damage in MCD.