title: Tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-6 concentrations in cerebrospinal fluid predict ventriculoperitoneal shunt infection.
abstract: OBJECTIVE
  To determine the diagnostic value of cerebrospinal fluid tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, and IL-6 released into the cerebrospinal fluid of patients with ventriculoperitoneal shunt infection.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Sixty-four patients requiring cerebrospinal fluid aspiration for suspected ventriculoperitoneal shunt malfunction.
  
  
  METHODS
  Cerebrospinal fluid samples were obtained by shunt aspiration at the time of patient presentation.
  
  
  RESULTS
  TNF-alpha and IL-1 beta concentrations were measured by enzyme-linked immunosorbent assay, and IL-6 activity by bioassay. The sensitivity, specificity, predictive values, and overall efficiency for each cytokine were determined based on the cerebrospinal fluid culture results. Ten patients had positive cerebrospinal fluid cultures, eight of which yielded Staphylococcus species, and one each Acinetobacter and Pseudomonas. Cerebrospinal fluid TNF-alpha, IL-1 beta, IL-6, protein, and leukocyte concentrations were significantly increased in patients with shunt infection. Cerebrospinal fluid IL-6 activity had the highest diagnostic accuracy of the cytokines evaluated, with sensitivity of 80% and specificity of 98%.
  
  
  CONCLUSIONS
  The presence of cerebrospinal fluid inflammatory cytokines strongly suggests ventriculoperitoneal shunt infection. Detection of these cytokines in the cerebrospinal fluid could be used for earlier diagnosis of bacterial infection.
authors.affiliation: Department of Pediatrics, Children's Hospital of Michigan, Detroit 48201, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Asi-Bautista
authors.forename: S M
authors.initials: SM
authors.lastname: Heidemann
authors.forename: K L
authors.initials: KL
authors.lastname: Meert
authors.forename: A I
authors.initials: AI
authors.lastname: Canady
authors.forename: A P
authors.initials: AP
authors.lastname: Sarnaik
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007375:Interleukin-1 / Q000134:cerebrospinal fluid*; D015850:Interleukin-6 / Q000134:cerebrospinal fluid*; D007958:Leukocyte Count; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D014409:Tumor Necrosis Factor-alpha / Q000134:cerebrospinal fluid*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
chemical_list: D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha