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The Diagnostic Value of CSF Tumor Necrosis Factor-α for Early Diagnosis of Bacterial Meningitis

Journal of the Korean Pediatric Society 1998;41(8):1078-1083.
Published online August 15, 1998.
The Diagnostic Value of CSF Tumor Necrosis Factor-α for Early Diagnosis of Bacterial Meningitis
So Young Park, Soo Ja Hwang, Eun Ae Park, Jung Wan Seo, Seung Joo Lee
Department of Pediatrics, Ewha Womans University, College of Medicine, Seoul, Korea
세균성 뇌막염의 조기 진단을 위한 뇌척수액 Tumor Necrosis Factor-α의 임상적 가치
박소영, 황수자, 박은애, 서정완, 이승주
이화여자대학 의과대학 소아과학교실
Correspondence: 
Eun Ae Park, Email: 1
Abstract
Purpose
: During the course of bacterial meningitis, TNF-α produced by macrophages and monocytes in response to LPS and other inflammatory and immune stimulation, is now recognized as a primary mediator in the pathogenesis of infection, injury and inflammation and in the process of host defence. TNF-α was increased vascular permeability by inducing morphologic and structural changes of endothelial cells by a direct toxic effect. The authers observed the concentration of CSF TNF-α, which was useful or not to differentiate bacterial meningitis from viral meningitis.
Methods
: In 57 children with meningitis(10 bacterial meningitis, 47 viral meningitis) were studied, at Ewha Womans University Hospital from Jan. 1995 to Oct. 1995. In the time of diagnosis, chemistry, smear, culture, latex agglutination test, TNF-α of CSF were checked. In bacterial meningitis, Follow up spinal tapping was performed 48 hours, 1 week after treatement, in viral meningitis, follow up was performed 2 to 7 days after treatement.
Results
: The positive rate of CSF TNF-α and mean concentration of CSF TNF-α were significantly different between two groups(bacterial meningitis : 90%(9/10), 1026±390.1pg/mL vs. viral meningitis : 6.3%(3/47), 12.6±61.9pg/mL)(P<0.01). Positive rate of the concentration of CSF TNF-α in the group of bacterial meningitis was changed 90% at pretreatement period, 80% at 48 hours after treatement, 10% at 7days after treatement. Changing of positive rate by the diagnositic method, the positive rate of culture of CSF was 10%, gram smear was 40%, latex agglutination was 50% at 48 hours after treatement.
Conclusion
: The concentration of CSF TNF-α was rapid and sensitive method of differentiation between bacterial meningitis and viral meningitis, which was reduced the use of excessive antivbiotics.
Key Words: Tumor necrosis factor(TNF)-α, Bacterial meningitis


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