ISSN:
1432-1440
Keywords:
Meningitis
;
Cerebrospinal fluid
;
α 1-Proteinase inhibitor
;
Elastase-α 1-proteinase inhibitor complex
;
Elastase inhibition capacity
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Summary Mortality and long-term neurologic sequelae are still frequent complications of meningitis despite effective antibiotic treatment. This suggests that pathogen-independent inflammatory mechanisms may play an important role in the course of this illness. Neutrophil granulocytes form the primary immune defense in meningitis. Once activated, these cells release elastase into the cerebrospinal fluid (CSF). Elastase may induce tissue damage if local antiproteinase capacity is low as under normal conditions. To define the relevance of this mechanism we studied 22 patients with meningitis. Concentrations of elastase in complex with the main antiproteinaseα 1-proteinase inhibitor (elastase-α 1PI),α 1-proteinase inhibitor (α 1PI), and elastase inhibition capacity (EIC) were measured in CSF of 9 patients with bacterial meningitis (BM), aged 1 month-214 years; 13 patients with non-bacterial meningitis (NBM), aged 1 month–15 years; and 20 patients in whom meningitis was excluded after spinal tap (control group), aged 6 months–15 years. The concentration of elastase-α 1PI in the BM group (median 552 μg/l) was significantly higher than in either the NBM group (median 30 μg/l,p〈0.01) or the control group (median 30 μg/l,p〈0.01). Similarly, theα 1PI-concentration in the BM group was significantly higher (median 113 mg/l) than either the NBM group (median 13.7 mg/l,p〈0.025) or the control group (median 6.3 mg/l,p〈0.001). The concentration of elastase-α 1PI shows a significant correlation with the duration of the infectious symptoms before admission to the hospital (r=0.51,p〈0.02), but not with the number of neutrophil granulocytesr=0.23, p=0.21). Free elastolytic capacity in CSF could be demonstrated in 4 patients: 1 with BM, 2 with NBM, and 1 with pertussis pneumonia and enzephalitis. The measured insufficiency of the proteinase-antiproteinase system may indicate high-risk patients in need of additional anti-inflammatory therapy, e.g., with corticosteroids, during the initial phase of meningitis.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01649304
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