title: [Meningitis and interferon-alpha in the cereprospinal fluid. What diagnostic and therapeutic approach? A case report].
abstract: BACKGROUND
  In meningitis without germs, the existence of an inflammatory syndrome leads toward a bacterial etiology while the detection of interferon-alpha (IFN-alpha) in the cerebrospinal fluid (CSF) argues for a viral meningitis. The coexistence of the inflammatory syndrome and the presence of IFN-alpha in the CSF makes this differentiation difficult. The reported case yields the picture and begs the question on the diagnostic approach and the required therapeutic attitude.
  
  
  METHODS
  A six-week-old infant, exclusively breast-fed, was hospitalized for fever. The examination showed an important inflammatory syndrome and meningeal attempt with a cellularity at 94/mm3 with 53% polymorphonuclear neutrophils, contrasting with normal proteinorrhachia and glycorrhachia. The IFN-alpha in the CSF was present at 4 UI/mL while the bacteriological culture and the viral search by PCR were negative. The clinical and biological worsening within the first 36 hours, in spite of the parenteral dispensation of a triple antibiotic therapy (amoxicillin, ceftriaxone, netilmicin), then a favorable clinical and biological response after adjunction of vancomycin, led toward a pneumococcal meningitis with reduced sensitivity to beta-lactams. The maternal antibiotic therapy by amoxicillin and its presence in the maternal milk favored the hypothesis of a decapitated bacterial meningitis.
  
  
  CONCLUSIONS
  In the presence of a meningitis without germs, the coexistence of a sizable inflammatory syndrome and the detection of IFN-alpha in the CSF must be considered as an unusual phenomenon and motivate the pursuit of antibiotic therapy until viral identification.
authors: Service de pédiatrie, centre hospitalier, Saint-Denis, France.
authors: C
authors: C
authors: Mbuila
authors: M K
authors: MK
authors: Mangyanda
authors: H
authors: H
authors: Nzenzo
authors: A
authors: A
authors: Ntimansiemi
authors: J P
authors: JP
authors: Helias
authors: M
authors: M
authors: Croisille
authors: P
authors: P
authors: Hayat
authors: J
authors: J
authors: Lorilloux
mesh_terms: D000658:Amoxicillin / Q000493:pharmacokinetics / Q000627:therapeutic use; D001942:Breast Feeding; D006801:Humans; D007223:Infant; D016898:Interferon-alpha / Q000134:cerebrospinal fluid*; D008297:Male; D008582:Meningitis, Aseptic / Q000175:diagnosis* / Q000188:drug therapy; D008895:Milk, Human / Q000382:microbiology; D010406:Penicillins / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D016898:Interferon-alpha; D010406:Penicillins; D000658:Amoxicillin