CEREBROSPINAL-FLUID INTERLEUKIN-1-BETA INTERLEUKIN-1 RECEPTOR ANTAGONIST BALANCE AND TUMOR-NECROSIS-FACTOR-ALPHA CONCENTRATIONS IN TUBERCULOUS, VIRAL AND ACUTE BACTERIAL-MENINGITIS

The levels of interleukin-1 beta, IL-1 receptor antagonist and tumor n ecrosis factor-alpha (TNF-alpha) were analyzed in 19 cases of tubercul ous, 14 cases of viral, and 22 cases of acute bacterial meningitis, an d in 18 control: subjects, 20 patients (91%) with acute bacterial and 8(42%) with tuberculous meningitis had detectable amounts of TNF-alpha in the initial cerebrospinal fluid (CSF) sample (mean 1044 +/- 131 pg /ml, range 95-1950, and mean 61 +/- 23 pg/ml, range 25-300, respective ly), whereas TNF-alpha was not detectable in any of the patients with viral meningitis or in any of the control subjects. IL-1 beta levels w ere 767 +/- 110 pg/ml (185-2000) in acute bacterial, 345 +/- 63 pg/ml (50-670) in tuberculous, 257 +/- 70 pg/ml (20-700) in viral meningitis , and 37 +/- 4 pg/ml (10-68) in control subjects. Il-1 receptor antago nist concentrations were significantly elevated in all meningitis grou ps, without significant differences between the groups. Il-1 receptor antagonist levels were 2487 +/- 62 pg/ml (2250-2950) in acute bacteria l, 2216 +/- 82 pg/ml (1350-2550) in tuberculous and 1985 +/- 92 pg/ml (650-2500) in viral meningitis, and 154 +/- 26 pg/ml (20-245) in contr ol CSF samples. A positive correlation was found between TNF and IL-1 beta levels (p < 0.01), and TNF levels and conscious state (p < 0.05). The ratio of concentrations of IL-1 receptor antagonist to IL-1 beta was 3.2 in acute bacterial meningitis, 6.9 in tuberculous meningitis a nd 8.3 in viral meningitis. This ratio was significantly different bet ween the acute bacterial meningitis group and the other groups (p < 0. 01), which indicates that the balance between cytokines and antagonist s is of importance for the pathogenicity and diagnosis of central nerv ous system infections.