BLOOD-BRAIN-BARRIER DAMAGE IN PATIENTS WITH BACTERIAL-MENINGITIS - ASSOCIATION WITH TUMOR-NECROSIS-FACTOR-ALPHA BUT NOT INTERLEUKIN-1-BETA

Brain damage after meningeal infection could result from impairment of cerebral endothelial cell functions and disruption of blood-brain barriers. Tumor necrosis factor-alpha (TNF-alpha) and interleukin-1-beta (IL-1-beta) produce many of their effects by acting on endothelial cells. This study correlates levels of TNF-alpha and IL-1-beta in paired cerebrospinal fluid (CSF) and serum samples with the degree of blood-brain barrier damage, as manifested by CSF to serum albumin quotient, in 48 patients with bacterial meningitis and 66 controls. CSF levels of TNF-alpha and IL-1-beta in bacterial meningitis were significantly higher than in controls. Intrathecal levels of TNF-alpha, but not IL-1-beta, correlated with albumin quotient (P < .001), with degree of blood-brain barrier disruption (P < .001), and with disease severity and indices of meningeal inflammation. Sequential CSF samples demonstrated that IL-1-beta and TNF-alpha disappear from the CSF within 24 h of antibiotic treatment. Data presented here suggest that TNF-alpha is related to blood-brain barrier damage in bacterial meningitis and that its effect could be dissociated from that of IL-1-beta.