Clinical Value of T Helper Subsets Related Cytokines in Cerebrospinal Fluid for the Differential Diagnosis of Pretreated Pediatric Bacterial Meningitis

Publish Year: 1398
نوع سند: مقاله کنفرانسی
زبان: English
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ICCM13_010

تاریخ نمایه سازی: 25 آبان 1398

Abstract:

Background and Objectives: Bacterial meningitis (BM) is a severe form of the disease which can damage the brain tissue leading to permanent sequela and also death. So, rapid and accurate diagnosis and treatment of BM are beneficial to decreasing its pathogenesis. As bacterial culture is time consuming with high false negative rate in pretreated patients, measuring the biomarkers influencing the pathogenesis could be useful in discriminating of BM from non-BM. Given the important role of cytokines in the outcome of disease, we aimed to assess T helper (Th) related cytokines in the CSF of patients with BM meningitis pretreated with antibiotics for differential diagnosis from non-BM. Material and Methods: Four hundred eighty CSFs from children aged between 2mo to 14y, clinically suspicious to meningitis and pretreated with antibiotics were analyzed for routine diagnostic laboratory test and polymerase chain reaction (PCR) to detect bacterial (N. meningitides, S. pneumoniea and H. influenza b) and viral (HSV 1 and 2, CMV, EBV and Enterovirus) agents. According to lab finding, sixty-one CSF were included in the study and the levels of 13 cytokines such as IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-17A, IL-17F, IL-21, IL-22, IFN-γ) and TNF-α were measured using bead assay flow-cytometry method. Results: All bacterial cultures were negative, but 29 and 8 CSF were positive for bacterial and viral agents by PCR method, respectively. Comparison of bacterial and non-bacterial groups revealed that cytokines IL-6, IL-10 and IFN-γ were significantly up-regulated in BM. A positive correlation was observed between IL-6 with CSF leukocyte count, neutrophil/lymphocyte ratio and protein. Assessing Th subsets related cytokines showed increased levels of Th1, Th2, Th17, Th22 and Tfh in BM, compared with non-BM. Also, cytokines which were common between all Th subsets (IL-6, IL-10 and TNF-α) were significantly different between the study groups. ROC curve analysis revealed the best AUC for common Th related cytokines in discriminating BM. Conclusion: It seems that in pretreated children clinically suspicious to BM and with negative bacterial cultures, cytokines such as IL-6, IL-10 and IFN-γ can predict BM which could be beneficial for rapid diagnosis and treatment.

Authors

Peyman Mohammad Zadeh Jahani

School of Medicine, Bam University of Medical Sciences, Bam, Iran

Maedeh Jafari

Department of Pediatrics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

Maral Choopanizadeh

Professor Alborzi, Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Marzieh Jamalidoust

Professor Alborzi, Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran