TUMOR-NECROSIS-FACTOR-ALPHA, INTERLEUKIN-1-BETA, AND INTERLEUKIN-6 CONCENTRATIONS IN CEREBROSPINAL-FLUID PREDICT VENTRICULOPERITONEAL SHUNTINFECTION

Objective: To determine the diagnostic value of cerebrospinal fluid tu mor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, and IL-6 rel eased into the cerebrospinal fluid of patients with ventriculoperitone al shunt infection. Design: Prospective, observational study. Setting: University teaching hospital. Patients: Sixty-four patients requiring cerebrospinal fluid aspi ration for suspected ventriculoperitoneal sh unt malfunction. Interventions: Cerebrospinal fluid samples were obtai ned by shunt aspiration at the time of patient presentation. Measureme nts and Main Results: TNF-alpha and IL-1 beta concentrations were meas ured by enzyme linked immunosorbent assay, and IL-6 activity by bioass ay. The sensitivity, specificity, predictive values, and overall effic iency for each cytokine were determined based on the cerebrospinal flu id culture results. Ten patients had positive cerebrospinal fluid cult ures, eight of which yielded Staphylococcus species, and one each Acin etobacter and Pseudomonas. Cerebrospinal fluid TNF-alpha, IL-1 beta, I L-6, protein, and leukocyte concentrations were significantly increase d in patients with shunt infection. Cerebrospinal fluid IL-6 activity had the highest diagnostic accuracy of the cytokines evaluated, with s ensitivity of 80% and specificity of 98%. Conclusions: The presence of cerebrospinal fluid inflammatory cytokines strongly suggests ventricu loperitoneal shunt infection. Detection of these cytokines in the cere brospinal fluid could be used for earlier diagnosis of bacterial infec tion.