Vascular endothelial growth factor in bacterial meningitis: Detection in cerebrospinal fluid and localization in postmortem brain

Vascular endothelial growth factor (VEGF) is a potent vascular permeability factor and a mediator of brain edema. To assess the role of VEGF during ba cterial meningitis, VEGF was measured in cerebrospinal fluid (CSF) and bloo d of 37 patients with bacterial meningitis and 51 control patients, includi ng 16 patients with viral meningitis. Circulating VEGF levels were similar in bacterial meningitis patients and control patients. VEGF(CSF) was detect ed in 11 (30%) of 37 of bacterial meningitis patients (range, <25-633 pg/mL ) but in none of the control patients. The median VEGF index was 6.2 (range , 0.6-42), indicating intrathecal production. Median CSF cell counts, prote in levels, and CSF: serum albumin ratios were higher for patients with dete ctable VEGF(CSF), although the difference was not statistically significant . VEGF immunoreactivity in autopsy brain specimens was found in the inflamm atory infiltrate of patients with bacterial meningitis. These results indic ate that inflammatory cells secrete VEGF during bacterial meningitis and th at VEGF may contribute to blood-brain barrier disruption.