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Mediators of Inflammation
Volume 2013 (2013), Article ID 312476, 12 pages
http://dx.doi.org/10.1155/2013/312476
Research Article

The Causative Pathogen Determines the Inflammatory Profile in Cerebrospinal Fluid and Outcome in Patients with Bacterial Meningitis

1Neuroinfection Laboratory, Institute for Infectious Diseases, University of Bern, Friedbuehlstraße 51, 3010 Bern, Switzerland
2Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
3Swiss Tropical and Public Health Institute and University of Basel, 4051 Basel, Switzerland
4Section of Clinical Tropical Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany
5Biology Division, Spiez Laboratory, Federal Office for Civil Protection (FOCP), 3700 Spiez, Switzerland

Received 22 February 2013; Revised 28 May 2013; Accepted 4 June 2013

Academic Editor: Jonathan P. Godbout

Copyright © 2013 Denis Grandgirard et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. The brain’s inflammatory response to the infecting pathogen determines the outcome of bacterial meningitis (BM), for example, the associated mortality and the extent of brain injury. The inflammatory cascade is initiated by the presence of bacteria in the cerebrospinal fluid (CSF) activating resident immune cells and leading to the influx of blood derived leukocytes. To elucidate the pathomechanisms behind the observed difference in outcome between different pathogens, we compared the inflammatory profile in the CSF of patients with BM caused by Streptococcus pneumonia ( ), Neisseria meningitidis ( ), and Haemophilus influenza ( ). Methods. CSF inflammatory parameters, including cytokines and chemokines, MMP-9, and nitric oxide synthase activity, were assessed in a cohort of patients with BM from Burkina Faso. Results. Pneumococcal meningitis was associated with significantly higher CSF concentrations of IFN-γ, MCP-1, and the matrix-metalloproteinase (MMP-) 9. In patients with a fatal outcome, levels of TNF-α, IL-1β, IL-1RA, IL-6, and TGF-α were significantly higher. Conclusion. The signature of pro- and anti-inflammatory mediators and the intensity of inflammatory processes in CSF are determined by the bacterial pathogen causing bacterial meningitis with pneumococcal meningitis being associated with a higher case fatality rate than meningitis caused by N. meningitidis or H. influenzae.