[Meningitis and interferon-alpha in the cereprospinal fluid. What diagnostic and therapeutic approach? A case report].
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.
Mbuila
C
C
Service de pédiatrie, centre hospitalier, Saint-Denis, France.
Mangyanda
M K
MK
Nzenzo
H
H
Ntimansiemi
A
A
Helias
J P
JP
Croisille
M
M
Hayat
P
P
Lorilloux
J
J
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
D016898:Interferon-alpha; D010406:Penicillins; D000658:Amoxicillin