Measurement of Levels of Tumor Necrosis Factor-α and Interleukin-1β in the CSF of Patients with Meningitis of Different Etiologies: Utility in the Differential Diagnosis

• Published in: Clinical infectious diseases 1993-04, Vol.16 (4), p.534-539
• Main Authors: López-Cortés, L. F., Cruz-Ruiz, M., Gómez-Mateos, J., Jiménez-Hernández, D., Palomino, J., Jiménez, E.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Aseptic meningitis; Bacterial diseases; Bacterial diseases of the nervous system. Bacterial myositis; Biological and medical sciences; Cerebrospinal Fluid Proteins - analysis; Chi-Square Distribution; Child; Child, Preschool; Clinical Infectious Disease Articles; Cytokines; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Escherichia coli meningitis; Etiology; Female; Human bacterial diseases; Humans; Infant; Infectious diseases; Inflammation; Interleukin-1 - cerebrospinal fluid; Leukocyte Count; Male; Medical sciences; Meningitis - cerebrospinal fluid; Meningitis - diagnosis; Meningitis - pathology; Middle Aged; Necrosis; Neutrophils; Pneumococcal meningitis; Predictive Value of Tests; Sensitivity and Specificity; Tumor Necrosis Factor-alpha - cerebrospinal fluid; Tumor necrosis factors; Tumors; Viral meningitis
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/clind/16.4.534

We assayed tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) concentrations in CSF from patients with meningitis of different etiologies and tested the usefulness of these assays for differentiating between pyogenic meningitis and aseptic meningitis of different etiologies. We used a monoclonal-antibody ELISA to test 125 CSF specimens from patients whose cases were classified as follows: pyogenic meningitis (n = 20), viral meningitis (n = 22), self-resolving aseptic meningitis for which no specific diagnosis was made (n = 25), meningitis due to other infectious agents (n = 11), and neoplastic meningitis (n = 5); we also tested normal CSF from healthy patients (n = 20) and those with neurological diseases (n = 22). Levels of TNF-α were above 200 pg/mL in 16 of 20 patients with pyogenic meningitis, but not in patients in the other groups. Levels of IL-1β were above 100 pg/mL in 15 of 20 patients with pyogenic meningitis and in one patient with a brain abscess. A positive correlation between levels of these cytokines and different inflammatory parameters was noted, whereas an inverse relationship with the duration of symptoms was observed. With regard to diagnosis, measurement of TNF-α and IL-1β levels showed sensitivities of 84.2% and 78.9%, respectively; specificities of 100% and 99%, respectively; a positive predictive value of 1 and 0.93, respectively; and a negative predictive value of 0.97 and 0.96, respectively.