Cerebrospinal Fluid Cachectin/Tumor Necrosis Factor-α and Platelet-Activating Factor Concentrations and Severity of Bacterial Meningitis in Children

In prospective studies, tumor necrosis factor (TNFα) was detected in cerebrospinal fluid (CSF) of 33 of 38 children with bacterial meningitis (BM) but in none of 15 with viral meningitisZencephalitis P < .001). BM CSF TNFα (25,500 pgZml) correlated with CSF bacterial density (P < .01), CSF protein (P < .001), endotoxin (LPS) in gram-negative disease (P < .01), and consecutive febrile hospital days (P < .001); initial CSF TNFα >1000 pgZml was associated with seizures (P < .05). Only 5 children with BM (13%) had detectable plasma TNFa activity on admission. A higher proportion who died had detectable plasma TNFa activity compared with survivors (3/4 vs. 2/34, P < .005). Platelet-activating factor (PAF) in CSF was higher in 19 children with Haemophilus influenzae meningitis than in 17 controls (P < .01) and correlated with bacterial density (P < .01), CSF LPS (P < .01), CSF TNFa levels (P < .01), and the Herson-Todd severity score (P < .01). Elevated CSF TNFα and PAF are often present in children with BM and are associated with seizures and severity of disease. Detectable CSF TNFα appears to distinguish BM from viral meningitis.