title: Cerebrospinal fluid cytokines in the diagnosis of bacterial meningitis in infants.
abstract: Bacterial meningitis poses diagnostic challenges in infants. Antibiotic pretreatment and low bacterial density diminish cerebrospinal fluid (CSF) culture yield, while laboratory parameters do not reliably identify bacterial meningitis. Pro and anti-inflammatory cytokines are elevated in bacterial meningitis and may be useful diagnostic adjuncts when CSF cultures are negative.
  
  
  
  In a prospective cohort study of infants, we used cytometric bead arrays to measure tumor necrosis factor alpha (TNF-α), interleukin 1 (IL-1), IL-6, IL-8, IL-10, and IL-12 in CSF. Receiver operating characteristic (ROC) analyses and Principal component analysis (PCA) were used to determine cytokine combinations that identified bacterial meningitis.
  
  
  
  Six hundred and eighty four infants < 6 mo were included; 11 had culture-proven bacterial meningitis. IL-6 and IL-10 were the individual cytokines possessing greatest accuracy in diagnosis of culture proven bacterial meningitis (ROC analyses; area under the concentration-time curve (AUC) 0.91; 0.9103 respectively), and performed as well as, or better than combinations identified using ROC and PCA. CSF cytokines were highly correlated with each other and with CSF white blood cell count (WBC) counts in infants with meningitis. A subset of antibiotic pretreated culture-negative subjects demonstrated cytokine patterns similar to culture positive subjects.
  
  
  
  CSF cytokine levels may aid diagnosis of bacterial meningitis, and facilitate decision-making regarding treatment for culture negative meningitis.
authors.affiliation: Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, Pennsylvania.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Srinivasan
authors.affiliation: Center for Inflammation, Translational and Clinical Lung Research, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Laurie
authors.initials: L
authors.lastname: Kilpatrick
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio.|Division of Hospital Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, Pennsylvania.|Pennsylvania Hospital, Philadelphia, Pennsylvania.
authors.forename: Soraya
authors.initials: S
authors.lastname: Abbasi
authors.affiliation: Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, Pennsylvania.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Harris
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019540:Area Under Curve; D016207:Cytokines / Q000134:cerebrospinal fluid*; D003657:Decision Making; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007249:Inflammation; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D025341:Principal Component Analysis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D016207:Cytokines