Endotoxin concentrations in cerebrospinal fluid correlate with clinical severity and neurologic outcome of Haemophilus influenzae type B meningitis.
Endotoxin concentrations were measured in paired samples of cerebrospinal fluid from 38 patients with Haemophilus influenzae type b meningitis. On admission, the median concentration of endotoxin in cerebrospinal fluid was 104 ng/mL and decreased rapidly in follow-up samples. From 17 to 48 hours after admission, 50% of the patients had concentrations of less than 1 ng/mL. Endotoxin concentrations correlated significantly with concentrations of interleukin 1 beta, protein, and glucose in cerebrospinal fluid, duration of secondary fever, and neurologic abnormalities during hospitalization and on follow-up examinations. Twenty-eight percent of patients with endotoxin concentrations of 100 ng/mL or more on admission had long-term complications, compared with none of those with lower endotoxin concentrations (relative risk, 2.31; 95% confidence interval, 1.53 to 3.48). These results indicate that quantitation of endotoxin in cerebrospinal fluid could be a valuable aid in identifying those children at increased risk of complications during Haemophilus influenzae type b meningitis and provide additional evidence that the Haemophilus influenzae type b meningitis lipo-oligosaccharide is important in the pathogenesis of meningitis.
Department of Microbiology, University of Texas Southwestern Medical Center, Dallas 75235-9063.
J
J
Mertsola
W A
WA
Kennedy
D
D
Waagner
X
X
Sáez-Llorens
K
K
Olsen
E J
EJ
Hansen
G H
GH
McCracken
D000818:Animals; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D002675:Child, Preschool; D003907:Dexamethasone / Q000494:pharmacology / Q000627:therapeutic use; D004195:Disease Models, Animal; D004731:Endotoxins / Q000134:cerebrospinal fluid*; D005260:Female; D005500:Follow-Up Studies; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D007223:Infant; D007375:Interleukin-1 / Q000134:cerebrospinal fluid; D007958:Leukocyte Count; D008070:Lipopolysaccharides / Q000134:cerebrospinal fluid / Q000187:drug effects; D008297:Male; D008583:Meningitis, Haemophilus / Q000134:cerebrospinal fluid* / Q000150:complications / Q000188:drug therapy; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D011817:Rabbits; D012307:Risk Factors; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000134:cerebrospinal fluid
D002556:Cerebrospinal Fluid Proteins; D004731:Endotoxins; D007375:Interleukin-1; D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha; C023023:lipid-linked oligosaccharides; D003907:Dexamethasone; D005947:Glucose