CORRELATION OF TUMOR-NECROSIS-FACTOR LEVELS IN THE SERUM AND CEREBROSPINAL-FLUID WITH CLINICAL OUTCOME IN JAPANESE ENCEPHALITIS PATIENTS

To investigate the prognostic role of tumour necrosis factor (TNF) in Japanese encephalitis virus (JEV) infection, we measured the immunorea ctive forms of TNF concentrations in the serum and cerebrospinal fluid (CSF) of 47 laboratory-confirmed cases of JE. It was observed that TN F levels were elevated (>15 pgm/ml) in all the 47 serum samples (range 19.4-923.8 pg/ml), while in 46/47 CSF samples TNF was elevated (range 10.8-376 pg/ml). The mean (SD) TNF levels in the serum of fatal cases was 234.34 pg/ml (304.40) as compared to the mean of 85.31 pg/ml (SD 153.92) in nonfatal cases. Similar observations were also made with re spect to the TNF levels in the CSF; the mean of fatal cases was 69.39 pg/ml (SD 39.00) in contrast to the mean of 62.41 pg/ml (SD 75.25) of nonfatal cases. The increase in TNF levels did not show any correlatio n to the duration of illness. It was further observed that the mortali ty rate increased with increasing concentrations of TNF in the serum a nd CSF. Correlation of laboratory parameters to final outcome revealed that TNF concentrations above 50 pg/ml in serum correlated significan tly (P=.05) with a fatal outcome, whilst high levels of JEV-IgM antibo dies (>500 units) in the CSF correlated with a nonfatal outcome (P=.03 ). These results suggest that TNF can be used as a possible prognostic ator of a fatal outcome in JEV infection. (C) 1997 Wiley-Liss, Inc.