THE ROLE OF NITRIC-OXIDE IN BACTERIAL-MENINGITIS IN CHILDREN

To investigate the role of nitric oxide (NO) in bacterial meningitis,c oncentrations in serum, cerebrospinal fluid (CSF), or both of the prec ursor (L-arginine) and degradation products of NO (nitrate, nitrite) a nd tumor necrosis factor (TNF)-alpha were measured in 35 patients and 30 controls. CSF nitrate levels were significantly elevated, mainly du e to increased blood-brain barrier permeability, and are therefore not a good parameter for gauging endogenous NO production in the CSF comp artment. CSF NO/nitrite levels were significantly elevated in patients . NO/nitrite levels decreased over time (26%/6 h; P < .001). CSF level s of NO/nitrite correlated with those of TNF-alpha (r = .55; P = .001) and glucose (r = -.43; P = .02). CSF levels of L-arginine were lower in patients than in controls (P < .001). Dexamethasone did not exert a significant effect on NO metabolism. In conclusion, enhanced NO produ ction may contribute to anaerobic glycolysis and neurologic damage in bacterial meningitis.