Oxidative Stress in Cerebrospinal Fluid of Patients with Aseptic and Bacterial Meningitis

This study aimed to determine whether patients with aseptic and bacterial meningitis presented alterations in oxidative stress parameters of cerebrospinal fluid (CSF). A total of 30 patients were used in the research. The CSF oxidative stress status has been evaluated through many parameters, such as lipid peroxidation through thiobarbituric acid reactive substances (TBARS) and antioxidant defense systems such as superoxide dismutase (SOD), glutathione S-transferase (GST), reduced glutathione (GSH) and ascorbic acid. TBARS levels, SOD and GST activity increase in aseptic meningitis and in bacterial meningitis. The ascorbic acid concentration increased significantly in patients with both meningitis types. The reduced glutathione levels were reduced in CSF of patients with aseptic and bacterial meningitis. In present study we may conclude that oxidative stress contributes at least in part to the severe neurological dysfunction found in meningitis.     

Dexamethasone,Cerebrospinal Fluid Matrix Metalloproteinase Concentrations and Clinical Outcomes in Tuberculous Meningitis

Background

Adjunctive dexamethasone reduces mortality from tuberculous meningitis, but how it produces this effect is not known. Matrix metalloproteinases (MMPs) are important in the immunopathology of many inflammatory CNS diseases thus we hypothesized that that their secretion is important in TBM and might be influenced by dexamethasone.

Methodology/Principal Findings

The kinetics of cerebrospinal fluid (CSF) MMP and tissue inhibitors of MMPs (TIMPs) concentrations were studied in a subset of HIV uninfected adults (n = 37) with TBM recruited to a randomized, placebo-controlled trial of adjuvant dexamethasone. Analysis followed a pre-defined plan. Dexamethasone significantly reduced CSF MMP-9 concentrations in early follow up samples (median 5 days (range 3–8) of treatment), but had no significant influence on other MMPs/TIMPs. Additionally CSF MMP-9 concentration was strongly correlated to concomitant CSF neutrophil count.

Conclusions/Significance

Dexamethasone decreased CSF MMP-9 concentrations early in treatment and this may represent one mechanism by which corticosteroids improve outcome in TBM. The strong correlation between CSF MMP-9 and neutrophil count suggests that polymorphonuclear leukocytes may play a central role in the early pathogenesis of TBM.     

Multicenter Testing of the Rapid Quantification of Radical Oxygen Species in Cerebrospinal Fluid to Diagnose Bacterial Meningitis

Purpose

Meningitis is a serious concern after traumatic brain injury (TBI) or neurosurgery. This study tested the level of reactive oxygen species (ROS) in cerebrospinal fluid (CSF) to diagnose meningitis in febrile patients several days after trauma or surgery.

Methods

Febrile patients (temperature > 38°C) after TBI or neurosurgery were included prospectively. ROS were measured in CSF within 4 hours after sampling using luminescence in the basal state and after cell stimulation with phorbol 12-myristate 13-acetate (PMA). The study was conducted in a single-center cohort 1 (n = 54, training cohort) and then in a multicenter cohort 2 (n = 136, testing cohort) in the Intensive Care and Neurosurgery departments of two teaching hospitals. The performance of the ROS test was compared with classical CSF criteria, and a diagnostic decision for meningitis was made by two blinded experts.

Results

The production of ROS was higher in the CSF of meningitis patients than in non-infected CSF, both in the basal state and after PMA stimulation. In cohort 1, ROS production was associated with a diagnosis of meningitis with an AUC of 0.814 (95% confidence interval (CI) [0.684–0.820]) for steady-state and 0.818 (95% CI [0.655–0.821]) for PMA-activated conditions. The best threshold value obtained in cohort 1 was tested in cohort 2 and showed high negative predictive values and low negative likelihood ratios of 0.94 and 0.36 in the basal state, respectively, and 0.96 and 0.24 after PMA stimulation, respectively.

Conclusion

The ROS test in CSF appeared suitable for eliminating a diagnosis of bacterial meningitis.     

结核性脑膜炎颅神经损害与脑脊液特点的关系研究

目的:探讨结核性脑膜炎颅神经损害与脑脊液特点的关系。方法:回顾性收集我院神经内科确诊的173例结核性脑膜炎患者临床资料,将所有患者分为伴颅神经损害和不伴颅神经损害两组,对其临床特点及脑脊液外观、压力及细胞学、生化、免疫球蛋白结果进行统计学分析。结果:颅神经损害者占所有病人的22.5%(39/173),视神经损害占61.5%(24/39),外展神经损害占53.8%(21/39),动眼神经损害占15.4%(6/39),听神经损害占15.4%(6/39);颅神经损伤组较无颅神经损伤组脑脊液压力、蛋白质及Ig G、Ig M、Alb明显升高(P0.01或0.001),且颅神经损害者头颅MRI脑膜强化较无颅神经损害者差异有统计学意义(P0.001),而脑脊液外观、白细胞计数及比例两组间并无发现显著差异。结论:结核性脑膜炎患者伴颅神经损害时,脑脊液压力、蛋白质及部分免疫球蛋白较无颅神经损害者明显升高,这将有助于结核性脑膜炎合并颅神经损害的临床诊断,对于有颅神经损害的结核性脑膜膜炎患者加强并早期启动抗结核治疗,以减少蛋白质沉积,从而降低颅神经损害的发生率。     

Alterations in Lumbar Cerebrospinal Fluid Protein During Air Encephalography

A significant fall occurred in the protein content of successive specimens of lumbar cerebrospinal fluid (C.S.F.) withdrawn during the course of air encephalography in 57% of cases. No correlation was found between the fall in the protein concentration and the total volume of air injected or the total volume of C.S.F. withdrawn, but the size of the fall was greater when the initial lumbar C.S.F. protein concentration was raised. The importance of taking specimens for routine laboratory analysis before the injection of any air is emphasized.     

26例病毒性脑(膜)炎儿童脑脊液病原学特征研究

病毒是儿童脑(膜)炎发病的重要病原体,为全面了解脑(膜)炎儿童脑脊液中的病毒感染情况,采集2019年6月-2019年9月复旦大学附属儿科医院26例病毒性脑(膜)炎(Viral encephalitis and meningitis,VEVM)儿童脑脊液标本,通过两种核酸检测方法进行病毒检测.病毒宏基因组测序检测到小RNA病毒科(Picornaviridae,82.42％)、浓病毒亚科(Densovirinae,9.07％)、指环病毒科(Anelloviridae,3.21％)、圆环病毒科(Circoviridae,0.85％)、星状病毒科(Astroviridae,0.76％)和小双节 RNA 病毒科(Picobirnaviridae,0.38％),通过聚合酶链式反应(Polymerase chain reaction,PCR)检测到肠道病毒(Enterovirus,EV)、单纯疱疹病毒 1 型(Herpes simplex virus,HSV-1)、人单纯疱疹病毒4型(Epstein-Barr virus,EBV)及腮腺炎病毒(Mumps virus,MuV),检出率分别为42.31％、7.69％﹑7.69％和3.85％.本研究初步明确了26例VEVM儿童脑脊液病毒信息,为深入研究其病原学进化分析奠定了基础.     

脑脊液腺苷脱氨酶和干扰素-r水平在结核性脑膜炎中的诊断价值

目的：探讨脑脊液腺苷脱氨酶和干扰素-酌水平在结核性脑膜炎中的诊断价值。方法：选取2012 年6 月-2014 年6 月期间于 我院进行治疗的结核性脑膜炎患者50 例作为研究组,同期健康体检者50 例作为对照组1,50 例非结核性脑膜炎者作为对照组 2。检测脑脊液中腺苷脱氨酶和干扰素-酌水平,并进行比较。结果：研究组患者脑脊液中腺苷脱氨酶和干扰素-r水平分别为 （22.45± 4.23）U/L和（36.45± 13.56）ng/L;对照组1 患者脑脊液中腺苷脱氨酶和干扰素-r水平分别为（16.32± 3.24）U/L 和 （12.78± 2.67）ng/L,对照组2 患者脑脊液中腺苷脱氨酶和干扰素-r水平分别为（7.48± 4.01）U/L 和（13.25± 2.89）ng/L,三组比较 差异有统计学意义（P＜0.05）,其中研究组患者脑脊液中腺苷脱氨酶和干扰素-r水平显著高于对照组1 和对照组2,两两比较差 异均有统计学意义（均P＜0.05）。结论：脑脊液腺苷脱氨酶和干扰素-r在结核性脑膜炎患者中具有诊断价值,值得推广应用。