Cerebrospinal fluid cytokine levels and dexamethasone therapy in bacterialmeningitis

Objectives: cerebrospinal fluid (CSF) levels of interleukin (IL)-1 beta and tumor necrosis factor (TNF) alpha were measured to assess the effect and a pplication of dexamethasone (Dex) therapy for bacterial meningitis. Methods: associations between clinical findings and CSF parameters were fir st investigated, and prognosis was compared between 25 patients with Dex an d 12 without Dex therapy. Results: patients with the presence of disturbed consciousness showed highe r CSF levels of TNF alpha (mean: 3015 pg/ml) or protein (mean: 215 mg/dl) t han those without it (both, P<0.05). Simultaneous increase of TNF alpha (>1 000 pg/ml) and protein (>100 mg/dl) was observed in 80% of patients with pr ofoundly disturbed consciousness. Patients with Dex therapy presented highe r TNF alpha/protein levels at diagnosis than those without Dex therapy (P<0 .05). Despite worse conditions at diagnosis, only one of 14 Dex-treated pat ients whose initial CSF TNF alpha levels exceeded 1000 pg/ml developed deaf ness. On the other hand, two of four patients without Dex therapy who had t he same TNF alpha level suffered from psychomotor retardation. The differen ces in the frequency of sequelae between those with and without Dex therapy were significant in patients showing high TNF alpha level (P<0.05), but no t in those showing high CSF levels of IL-1 beta or protein. The logistic re gression analysis indicated that high CSF protein level (P<0.0001), or no D ex therapy (P=0.0001) was the independent risk factor for sequelae. Conclusions: although the study number was small, our observations suggeste d that CSF TNF alpha/protein levels reflected the neurologic severity, and implied that early Dex therapy might be beneficial for patients with promin ently high TNF alpha levels.