Hypothermia as an adjunctive treatment for severe bacterial meningitis

• Published in: Brain research 2000-10, Vol.881 (1), p.88-97
• Main Authors: Irazuzta, Jose E., Pretzlaff, Robert, Rowin, Mark, Milam, Kevin, Zemlan, Frank P., Zingarelli, Basilia
• Format: Article
• Language: English
• Subjects: Animals; Biological and medical sciences; Blood Pressure - physiology; Blood-Brain Barrier - physiology; Body Temperature - physiology; Cerebral perfusion pressure; Cerebrospinal fluid. Meninges. Spinal cord; Cleaved Tau protein; Hypothermia; Hypothermia, Induced - methods; Inflammation; Intracranial pressure; Intracranial Pressure - physiology; Male; Medical sciences; Meningitis; Meningitis, Bacterial - cerebrospinal fluid; Meningitis, Bacterial - physiopathology; Meningitis, Bacterial - therapy; Nervous system (semeiology, syndromes); Neurology; Nitric Oxide - cerebrospinal fluid; Peroxidase - metabolism; Rabbits; Streptococcal Infections - therapy; Streptococcus agalactiae; Subarachnoid Space - pathology
• ISSN: 0006-8993; 1872-6240
• DOI: 10.1016/S0006-8993(00)02894-8

Brain injury due to bacterial meningitis results in a high mortality rate and significant neurologic sequelae in survivors. The objective of this study was to determine if the application of moderate hypothermia shortly after the administration of antibiotics would attenuate the inflammatory response and increase in intracranial pressure that occurs in meningitis. For this study we used a rabbit model of severe Group B streptococcal meningitis. The first component of this study evaluated the effects of hypothermia on blood–brain barrier function and markers of inflammation in meningitic animals. The second part of the study evaluated the effects of hypothermia on intracranial pressure, cerebral perfusion pressure and brain edema. This study demonstrates that the use of hypothermia preserves CSF/serum glucose ratio, decreases CSF protein and nitric oxide and attenuates myeloperoxidase activity in brain tissue. In the second part of this study we show a decrease in intracranial pressure, an improvement in cerebral perfusion pressure and a decrease in cerebral edema in hypothermic meningitic animals. We conclude that in the treatment of severe bacterial meningitis, the application of moderate hypothermia initiated shortly after antibiotic therapy improves short-term physiologic measures associated with brain injury.