title: Myositis in children with meningococcal disease: a role for tumour necrosis factor-alpha and interleukin-8?
abstract: OBJECTIVE
  Myalgia is under-recognized in meningococcal disease (MCD). In septic shock, myositis is thought to be mediated by pro-inflammatory cytokines such as tumour necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8) and interleukin-6 (IL-6) but this has never previously been studied in MCD. We aimed to demonstrate whether muscle damage mediated via TNF-alpha and other pro-inflammatory cytokines occurs in MCD, as estimated by creatine kinase skeletal muscle isoenzyme (CK-MM) and cardiac isoenzyme (CK-MB) concentrations.
  
  
  METHODS
  A total of 68 children, median age 2.7 years, with a diagnosis of MCD were prospectively studied. Severity of disease was measured using the Glasgow Meningococcal Septicaemia Prognostic Score (GMSPS). Severe disease was defined as a GMSPS of > or =8. TNF-alpha, IL-8, IL-6 and IL-1Ra concentrations were determined on samples taken on admission.
  
  
  RESULTS
  CK-MM correlated significantly with TNF-alpha, IL-8 and GMSPS. There was no significant correlation between CK-MB and TNF-alpha or IL-6, but CK-MB correlated with GMSPS and IL-8. Fifty-six percent of children with MCD had evidence of muscle damage as manifested by elevated CK-MM.
  
  
  CONCLUSIONS
  TNF-alpha and IL-8 may be potential mediators in the pathophysiology of skeletal muscle damage in MCD.
authors.affiliation: Institute of Child Health, Royal Liverpool Children's Hospital, Alder Hey, Eaton Road, UK. edcarrol@liv.ac.uk
authors.forename: E D
authors.initials: ED
authors.lastname: Carrol
authors.forename: A P J
authors.initials: AP
authors.lastname: Thomson
authors.forename: K J
authors.initials: KJ
authors.lastname: Mobbs
authors.forename: W D
authors.initials: WD
authors.lastname: Fraser
authors.forename: J A
authors.initials: JA
authors.lastname: Sills
authors.forename: C A
authors.initials: CA
authors.lastname: Hart
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D052283:Creatine Kinase, MM Form; D005260:Female; D006801:Humans; D007223:Infant; D016209:Interleukin-8 / Q000097:blood*; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008589:Meningococcal Infections / Q000150:complications* / Q000201:enzymology / Q000378:metabolism*; D009220:Myositis / Q000201:enzymology / Q000378:metabolism* / Q000382:microbiology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D016209:Interleukin-8; D007527:Isoenzymes; D014409:Tumor Necrosis Factor-alpha; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D052283:Creatine Kinase, MM Form