ROLE OF CSF IL 1β AND IL 6 IN DIAGNOSIS OF MENINGITIS IN PEDIATRIC PATIENTS AND THEIR POTENTIAL ROLE AS MARKERS OF DIFFERENTIAL DIAGNOSIS IN ASEPTIC AND BACTERIAL MENINGITIS.

Abstract

Background: Acute bacterial meningitis in children is associated with high mortality and morbidity in developing countries due to poor immunisation coverage, delayed diagnosis and lack of appropriate treatment. Although cerebrospinal fluid microscopic and routine examination has been used as a tool to diagnose bacterial meningitis, it has poor sensitivity and specificity. Detection of cytokines such as IL 1β & IL 6 in the CSF has been suggested for early diagnosis and differentiation of various etiological subgroups of meningitis. In this study we investigated the usefulness of IL 1β and IL 6 in the diagnosis of meningitis and their role in differentiating between the aseptic and bacterial meningitis.

Objectives: To study the levels of IL 1β & IL 6 in meningitis of different etiologies and their role in differentiating between aseptic and bacterial meningitis

Material and Methods: the study was a prospective observational study conducted over a period of two years. Pateints were selected on the basis of Nigrovics protocol for meningitis and segregated as cases of aseptic and bacterial meningitis on the basis of bacterial meningitis score. A total of 77 patients were enrollred for the study. Routine investigation of meningitis were drawn at the time of admission. CSF of the patients was preserved at -20℃ and subjected to ELISA for determination of IL 1β and IL 6 levels at the end of study.

Results: The mean concentrations of cerebrospinal fluid interleukin 1β and interleukin 6 were 281.7±23.82 and 222.76±83 respectively in children with bacterial meningitis and were significantly increased than the levels of IL 1β and IL 6 in those of viral meningitis group (49.13±27.16 and 18.95±21.99. ;p< 0.001) . At the optimum cut off value based on the receiver operating characteristic curve, the csf cytokines (IL 1β: 227.5pg/ml and IL 6: 103.5pg/ml) showed sensitivity and specificity of 96% &100% respectively for diagnosis of bacterial meningitis and differentiation of bacterial from aseptic meningitis.

Conclusion: The increased levels of CSF cytokines (IL 1β & IL 6) provides a rapid and reliable method for differentiation of bacterial from aseptic meningitis.