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Wang C, Xu H, Deng J, Yu H, Chen Y, Wang S, Huang W, Hao J, Wang C, Deng H, Chen Y. Prognostic factors in pediatric pneumococcal meningitis patients in mainland China: a retrospective multicenter study. Infect Drug Resist 2019; 12:1501-1512. [PMID: 31239727 PMCID: PMC6560191 DOI: 10.2147/idr.s193671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/28/2019] [Indexed: 01/15/2023] Open
Abstract
Background: Prognosis of pneumococcal meningitis (PM) remains very poor, especially in less developed countries. Currently, few multi-centric studies on pediatric PM have been reported in mainland China. Objectives: This study aimed to explore the correlation of clinical and laboratory findings with complications and prognosis in pediatric PM. Methods: The pediatric PM patients were retrospectively recruited from ten pediatric tertiary hospitals across China between January 2013 and June 2018. Clinical, biochemical, and microbiological data and follow-up information were collected. Predictive factors for complications and prognostic factors for overall survival (OS) and sequelae-free survival (SFS) were analyzed. Results: A total of 132 pediatric PM patients were included. Seventy-one patients had complications, 25 patients died, and 39 patients had neurological sequelae. Multivariate logistic regression suggested that age less than 28 months (adjusted OR=2.654, 95%CI=1.067–6.600, P=0.036) and lower white blood cells in blood (aOR=3.169, 95%CI=1.395–7.202, P=0.006) were associated with high risk of complications. Multivariate Cox’s proportional hazard regression suggested that age less than 28 months (aHR=6.479, 95%CI=1.153–36.404, P=0.034), coma (aHR=9.808, 95%CI=2.802–34.323, P=0.000), and non-adjuvant steroid therapy (aHR=4.768 95%CI=1.946–11.678, P=0.001) were independent prognostic factors for poor OS; coma (aHR=5.841, 95%CI=2.652–12.864, P=0.000), septic shock on admission (aHR=2.949, 95%CI=1.049–8.290, P=0.040), and lower glucose level in cerebrospinal fluid (CSF) (aHR=2.523, 95%CI=1.336–4.765, P=0.004) were independent prognostic factors for poor SFS. Conclusion: Age, coma, and adjuvant steroid therapy were independent factors for OS, while coma, septic shock on admission, and lower glucose level in CSF were independent factors for SFS in pediatric PM patients. These factors might be used to identify PM patients with poor prognosis and guide individual treatment.
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Affiliation(s)
- Caiyun Wang
- Infection Disease Department, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, People's Republic of China
| | - Hongmei Xu
- Infection Disease Department, Children's Hospital of Chongqing Medical University, Chongqing 400014, People's Republic of China
| | - Jikui Deng
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen 518038, People's Republic of China
| | - Hui Yu
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, People's Republic of China
| | - Yiping Chen
- Infection Disease Department, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, People's Republic of China
| | - Shifu Wang
- Department of Children's Medical Laboratory Diagnosis Center, Qilu Children's Hospital of Shandong University, Jinan, 250022, People's Republic of China
| | - Weichun Huang
- Department of Clinical Laboratory, Shanghai Children's Medical Center of Shanghai Jiaotong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Jianhua Hao
- Infection Disease Department, Kaifeng Children's Hospital, Kaifeng 475000, People's Republic of China
| | - Chun Wang
- Clinical Laboratory, Children's Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, 200040, People's Republic of China
| | - Huiling Deng
- Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, 710003, People's Republic of China
| | - Yinghu Chen
- Infection Disease Department, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, People's Republic of China
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Zhang P, Zhang N, Liu L, Zheng K, Zhu L, Zhu J, Cao L, Jiang Y, Liu G, He Q. Polymorphisms of toll-like receptors 2 and 9 and severity and prognosis of bacterial meningitis in Chinese children. Sci Rep 2017; 7:42796. [PMID: 28202935 PMCID: PMC5311876 DOI: 10.1038/srep42796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/13/2017] [Indexed: 02/07/2023] Open
Abstract
Toll-like receptors (TLRs) play a crucial role in innate immunity, protecting the host from bacterial pathogens. We investigated whether bacterial meningitis (BM) in children was associated with gene polymorphisms in TLR2 (rs3804099), TLR3 (rs3775291 and rs3775290) and TLR9 (rs352139 and rs352140). Blood samples were taken from 218 child patients with confirmed BM and 330 healthy adult controls (HC) and polymorphisms of these genes were analyzed by PCR-based sequencing. For TLR2 rs3804099, frequencies of the minor allele C were markedly higher in patients with severe BM (defined as CSF glucose concentration ≤ 1.5 mmol/L and seizures) than those without (43.5% and 40.1% vs. 30.1% and 29.1%, p = 0.008 and p = 0.016, respectively). For TLR9 rs352139, patients who carried genotype AA and minor allele A developed seizures less often than those without (OR = 0.289, p = 0.003 and OR = 0.568, p = 0.004, respectively). However, for TLR9 rs352140, patients who carried genotype TT and minor allele T developed seizures more often than those without (OR = 3.385, p = 0.004 and OR = 1.767, p = 0.004, respectively). Our finding suggested that genetic variations in TLR2 and TLR9 are associated with severity and prognosis of bacterial meningitis in Chinese children. However, the results should be interpreted with caution since the number of subjects included was limited.
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Affiliation(s)
- Pingping Zhang
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Nan Zhang
- Department of Medical Microbiology and Research Centre of Microbiome, Capital Medical University, Beijing 100069, China
| | - Linlin Liu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Kai Zheng
- Department of Medical Microbiology and Research Centre of Microbiome, Capital Medical University, Beijing 100069, China
| | - Liang Zhu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Junping Zhu
- Department of Medical Microbiology and Research Centre of Microbiome, Capital Medical University, Beijing 100069, China
| | - Lina Cao
- Department of Medical Microbiology and Research Centre of Microbiome, Capital Medical University, Beijing 100069, China
| | - Yiyuan Jiang
- Department of Medical Microbiology and Research Centre of Microbiome, Capital Medical University, Beijing 100069, China
| | - Gang Liu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Qiushui He
- Department of Medical Microbiology and Research Centre of Microbiome, Capital Medical University, Beijing 100069, China.,Department of Medical Microbiology and Immunology, University of Turku, Turku 20520, Finland
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Lack of Proinflammatory Cytokine Interleukin-6 or Tumor Necrosis Factor Receptor-1 Results in a Failure of the Innate Immune Response after Bacterial Meningitis. Mediators Inflamm 2016; 2016:7678542. [PMID: 27057100 PMCID: PMC4749820 DOI: 10.1155/2016/7678542] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/04/2016] [Indexed: 12/27/2022] Open
Abstract
The most frequent pathogen that causes bacterial meningitis is the Gram-positive bacterium Streptococcus pneumoniae. By entering the brain, host cells will be activated and proinflammatory cytokines like interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) are released. The goal of the current study was to examine the interaction between IL-6 and TNFR1 as receptor for TNF-α and the innate immune response in vivo in a model of Streptococcus pneumoniae-induced meningitis. For the experiments IL-6(-/-), TNFR1(-/-), and TNFR1-IL-6(-/-) KO mice were used. Our results revealed higher mortality rates and bacterial burden after infection in TNFR1(-/-), IL-6(-/-), and TNFR1-IL-6(-/-) mice and a decreased immune response including lower neutrophil infiltration in the meninges of TNFR1(-/-) and TNFR1-IL-6(-/-) mice in contrast to IL-6(-/-) and wild type mice. Furthermore, the increased mortality of TNFR1(-/-) and TNFR1-IL-6(-/-) mice correlated with decreased glial cell activation compared to IL-6(-/-) or wild type mice after pneumococcal meningitis. Altogether, the results show the importance of TNFR1 and IL-6 in the regulation of the innate immune response. The lack of TNFR1 and IL-6 results in higher mortality by weakened immune defence, whereas the lack of TNFR1 results in more severe impairment of the innate immune response than the lack of IL-6 alone.
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Wee LYJ, Tanugroho RR, Thoon KC, Chong CY, Choong CT, Krishnamoorthy S, Maiwald M, Tee NWS, Tan NWH. A 15-year retrospective analysis of prognostic factors in childhood bacterial meningitis. Acta Paediatr 2016; 105:e22-9. [PMID: 26426265 DOI: 10.1111/apa.13228] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/06/2015] [Accepted: 09/23/2015] [Indexed: 01/17/2023]
Abstract
AIM This retrospective chart review aimed to identify factors in childhood bacterial meningitis that predicted disease severity and long-term outcome. METHODS The study included 112 episodes of microbiologically confirmed bacterial meningitis in children aged three days to 15 years who were admitted to a Singapore hospital from 1998 to 2013. RESULTS The mortality rate was 6%, and 44% required intensive care unit (ICU) admission. Predictive factors associated with ICU admission included pneumococcal meningitis, with an odds ratio (OR) of 5.2 and 95% confidence interval (CI) of 1.5-18.2, leukopenia (OR 5.6, 95% CI 1.7-17.9) and a cerebrospinal fluid (CSF):serum glucose ratio <0.25 (OR 4.5, 95% CI 1.4-14.4). An initial CSF white blood cell count >1000/mm(3) (OR 0.26, 95% CI 0.086-0.76) was negatively associated with ICU admission. Five years after meningitis, 32% had residual sequelae, and the associated prognostic factors were Haemophilus influenzae type b (Hib) meningitis (OR 29.5, 95% CI 2-429), seizures during their inpatient stay (OR 10.6, 95% CI 1.9-60.2) and septic shock (OR 8.4, 95% CI 1.1-62.1). CONCLUSION As mortality was low in this bacterial meningitis study, ICU admission was used as a marker of disease severity. These findings underscore the importance of the pneumococcal and Hib meningitis vaccines.
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Affiliation(s)
- Liang Yi Justin Wee
- Department of Paediatrics; KK Women's and Children's Hospital; Singapore City Singapore
| | | | - Koh Cheng Thoon
- Infectious Disease Service; Department of Paediatrics; KK Women's and Children's Hospital; Singapore City Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore City Singapore
- Duke-National University of Singapore Graduate Medical School; Singapore City Singapore
| | - Chia Yin Chong
- Infectious Disease Service; Department of Paediatrics; KK Women's and Children's Hospital; Singapore City Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore City Singapore
- Duke-National University of Singapore Graduate Medical School; Singapore City Singapore
| | - Chew Thye Choong
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore City Singapore
- Duke-National University of Singapore Graduate Medical School; Singapore City Singapore
- Neurology Service; Department of Paediatrics; KK Women's and Children's Hospital; Singapore City Singapore
| | | | - Matthias Maiwald
- Duke-National University of Singapore Graduate Medical School; Singapore City Singapore
- Department of Pathology and Laboratory Medicine; KK Women's and Children's Hospital; Singapore City Singapore
- Department of Microbiology; Yong Loo Lin School of Medicine; National University of Singapore; Singapore City Singapore
| | - Nancy Wen Sim Tee
- Duke-National University of Singapore Graduate Medical School; Singapore City Singapore
- Department of Pathology and Laboratory Medicine; KK Women's and Children's Hospital; Singapore City Singapore
| | - Natalie Woon Hui Tan
- Infectious Disease Service; Department of Paediatrics; KK Women's and Children's Hospital; Singapore City Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore City Singapore
- Duke-National University of Singapore Graduate Medical School; Singapore City Singapore
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Omran A, Peng J, Zheng C, Xue J, Xiang QL, Yin F. The Expression of Interleukin-1b and miRNA-146a in the Cerebral Cortex of Acute Escherichia Coli Meningitis Immature Rat Model. Afr J Infect Dis 2013; 6:41-7. [PMID: 23878714 DOI: 10.4314/ajid.v6i2.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The main limitation to advances in treatment of bacterial meningitis and its complications is the incomplete knowledge of the pathogenesis and pathophysiology of this disease. The aim of this research is to detect the expression of interleukin (IL)-1β as pro-inflammatory cytokine and miRNA (miR)-146a as post transcriptional inflammation associated microRNA (miRNA) in the cerebral cortex of acute Escherichia coli (E. coli) meningitis immature rat model. Immature rats in the post natal day 11 (PN11) were used to construct a model of acute E. coli meningitis and served as controls. The expression of IL-1β and miR-146a were detected in the cerebral cortex by reverse transcription polymerase chain reaction (RT-PCR) and real-time quantitative PCR (qPCR) analysis respectively, 24 hours after bacterial inoculation. In the cerebral cortical tissue of acute E. coli meningitis immature rat model the IL-1β expression was significantly upregulated while the miR-146a expression was significantly downregulated. This study tried to add a new insight on the molecular basis of the E. coli meningitis pathogenesis at its very early stage through detecting the expression of IL-1β and miR-146a in the cerebral cortex of the infected immature rats. Consequently, modulation of the IL-1β- miR-146a axis may be a new target for treatment of acute E. coli meningitis.
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Affiliation(s)
- Ahmed Omran
- Department of Pediatrics, Xiangya Hospital of Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, China
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Kestner M, Rosler AE, Baumgärtner M, Lindner A, Orth M. CSF interleukin 6 – a useful biomarker of meningitis in adults?/Liquor Interleukin 6 – ein sinnvoller Biomarker für die Meningitis beim Erwachsenen. ACTA ACUST UNITED AC 2011. [DOI: 10.1515/jlm.2011.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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7
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Law WS, Li SFY, Kricka LJ. Detection of enteropathogenic Escherichia coli by microchip capillary electrophoresis. Methods Mol Biol 2009; 509:169-179. [PMID: 19212722 DOI: 10.1007/978-1-59745-372-1_12] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
There is always a need to detect the presence of microorganisms, either as contaminants in food and pharmaceutical industries or bioindicators for disease diagnosis. Hence, it is important to develop efficient, rapid, and simple methods to detect microorganisms. Traditional culturing method is unsatisfactory due to its long incubation time. Molecular methods, although capable of providing a high degree of specificity, are not always useful in providing quick tests of presence or absence of microorganisms. Microchip elec-trophoresis has been recently employed to address problems associated with the detection of microorganisms due to its high versatility, selectivity, sensitivity, and short analysis times. In this work, the potential of PDMS-based microchip electrophoresis in the identification and characterization of microorganism was evaluated. Enteropathogenic E. coli (EPEC) was selected as the model microorganism. To obtain repeat-able separations, sample pretreatment was found to be essential. Microchip electrophoresis with laser-induced fluorescence detection could potentially revolutionize certain aspects of microbiology involving diagnosis, profiling of pathogens, environmental analysis, and many others areas of study.
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Affiliation(s)
- Wai S Law
- Department of Chemistry, National University of Singapore, Singapore, Republic of Singapore
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8
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Nagesh Babu G, Kumar A, Kalita J, Misra U. Proinflammatory cytokine levels in the serum and cerebrospinal fluid of tuberculous meningitis patients. Neurosci Lett 2008; 436:48-51. [DOI: 10.1016/j.neulet.2008.02.060] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 02/21/2008] [Accepted: 02/22/2008] [Indexed: 10/22/2022]
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9
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Law WS, Tay ETT, Feng H, Yu L, Zhao JH, Li SFY. Rapid identification of purified enteropathogenic Escherichia coli by microchip electrophoresis. J Sep Sci 2007; 30:1446-52. [PMID: 17623424 DOI: 10.1002/jssc.200600452] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this work, the potential of PDMS-based microchip electrophoresis in the identifications and characterizations of microorganism was evaluated. Enteropathogenic E. coli (EPEC) was selected as the model microorganism. In this study, separation parameters such as applied voltage, concentrations of buffer and buffer modifier, injection voltage, and duration of injection had been investigated and optimized. Determination of EPEC bacteria could be completed within 2 min with good reproducibility. RSDs were less than 0.5 and 5% in migration time and peak area, respectively. Separation efficiency corresponding to plate number of more than 100,000 was achieved. In order to obtain reproducible separations, sample pretreatment was found to be essential. Microchip electrophoresis with LIF detection could potentially revolutionize certain aspects of microbiology involving diagnosis, profiling of pathogens, environmental analysis, and many other areas of study.
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Affiliation(s)
- Wai Siang Law
- Department of Chemistry, National University of Singapore, Republic of Singapore
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10
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Mukai AO, Krebs VLJ, Bertoli CJ, Okay TS. TNF-alpha and IL-6 in the diagnosis of bacterial and aseptic meningitis in children. Pediatr Neurol 2006; 34:25-9. [PMID: 16376274 DOI: 10.1016/j.pediatrneurol.2005.06.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 06/06/2005] [Indexed: 11/23/2022]
Abstract
The objective of this study was to analyze the usefulness of tumor necrosis factor-alpha and interleukin-6 cerebrospinal fluid concentrations for the differential diagnosis between bacterial and aseptic meningitis in children and in the prognostic evaluation. A cross-sectional study was performed on 35 children between 1 month and 12 years of age with suspected meningitis. Cytokines determination was performed by enzyme-linked immunosorbent assay technique. The Mann-Whitney test and Spearman's correlation coefficients were used for statistical analysis. Six children presented bacterial meningitis, 13 aseptic, and 16 had no meningitis. The tumor necrosis factor-alpha concentrations were significantly higher in the bacterial meningitis group as compared with the aseptic group (P = 0.001) and among groups with and without meningitis (P = 0.000). There was correlation between tumor necrosis factor-alpha and cerebrospinal fluid leukocytes (P = 0.019), protein (P = 0.000), and glucose (P = 0.038). There was no association between cytokines and complications of the meningitis. The tumor necrosis factor-alpha concentrations in the cerebrospinal fluid were useful markers for distinguishing bacterial from aseptic meningitis and were demonstrated to be useful in evaluating the intensity of the inflammatory process in the central nervous system.
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Affiliation(s)
- Adriana O Mukai
- Department of Pediatrics, Taubaté University, São Paulo, Brazil
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Selvaraj SK, Prasadarao NV. Escherichia coliK1 inhibits proinflammatory cytokine induction in monocytes by preventing NF-κB activation. J Leukoc Biol 2005; 78:544-54. [PMID: 15894582 DOI: 10.1189/jlb.0904516] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Phagocytes are well-known effectors of the innate immune system to produce proinflammatory cytokines and chemokines such as tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-1beta, and IL-8 during infections. Here, we show that infection of monocytes with wild-type Escherichia coli K1, which causes meningitis in neonates, suppresses the production of cytokines and chemokines (TNF-alpha, regulated on activation, normal T expressed and secreted, macrophage-inflammatory protein-1beta, IL-1beta, and IL-8). In contrast, infection of monocytes with a mutant E. coli, which lacks outer membrane protein A (OmpA- E. coli) resulted in robust production of cytokines and chemokines. Wild-type E. coli K1 (OmpA+ E. coli) prevented the phosphorylation and its degradation of inhibitor of kappaB, thereby blocking the translocation of nuclear factor (NF)-kappaB to the nucleus. OmpA+ E. coli-infected cells, subsequently subjected to lipopolysaccharide challenge, were crippled severely in their ability to activate NF-kappaB to induce cytokine/chemokine production. Selective inhibitors of the extracellular signal-regulated kinase (ERK) 1/2 pathway and p38 mitogen-activated protein kinase (MAPK), but not Jun N-terminal kinase, significantly reduced the activation of NF-kappaB and the production of cytokines and chemokines induced by OmpA- E. coli, indicating a role for these kinases in the NF-kappaB/cytokine pathway. It is interesting that the phosphorylation of ERK 1/2 and p38 MAPK was notably reduced in monocytes infected with OmpA+ E. coli when compared with monocytes infected with OmpA- E. coli, suggesting that the modulation of upstream events common for NF-kappaB and MAPKs by the bacterium is possible. The ability of OmpA+ E. coli K1 to inhibit the macrophage response temporarily may enable bacterial survival and growth within the host for the onset of meningitis by E. coli K1.
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Affiliation(s)
- Suresh K Selvaraj
- Division of Infectious Diseases, The Saban Research Institute, Childrens Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA 90027, USA
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12
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Krebs VLJ, Okay TS, Okay Y, Vaz FAC. Tumor necrosis factor-alpha, interleukin-1beta and interleukin-6 in the cerebrospinal fluid of newborn with meningitis. ARQUIVOS DE NEURO-PSIQUIATRIA 2005; 63:7-13. [PMID: 15830057 DOI: 10.1590/s0004-282x2005000100002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the usefulness of determining the cerebrospinal fluid (CSF) levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta) and interleukin-6 (IL-6) for the early diagnosis and evaluation of the prognosis of neonatal meningitis. METHOD We studied 54 newborn that underwent lumbar puncture. Thirty patients had meningitis and 24 were the control group. CSF and sera were obtained at the moment of suspicion of meningitis and stored at -70 degrees C. Cytokines were performed by enzyme-linked immunosorbent assay method. RESULTS CSF cytokines were detected in all the newborn with meningitis. TNF-alpha was detected in the CSF in 63.3% of the neonates, IL-1beta in 73.3% and IL-6 in 96.6%. The CSF levels were significantly higher than serum in neonates with meningitis. There was no correlation between the CSF levels of cytokines and neurologic complications. CONCLUSION The detection of TNF-alpha, IL-1beta and IL-6 in the CSF is of great value in order to achieve a early diagnosis of neonatal meningitis. Among the three cytokines analyzed, IL-6 was the best indicator of meningeal inflammation.
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Affiliation(s)
- Vera Lúcia Jornada Krebs
- Instituto da Criança, Hospital das Clínicas, Department of Pediatrics, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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Garthoff LH, Sobotka TJ. From farm to table to brain: foodborne pathogen infection and the potential role of the neuro-immune-endocrine system in neurotoxic sequelae. Nutr Neurosci 2002; 4:333-74. [PMID: 11845817 DOI: 10.1080/1028415x.2001.11747373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The American diet is among the safest in the world; however, diseases transmitted by foodborne pathogens (FBPs) still pose a public health hazard. FBPs are the second most frequent cause of all infectious illnesses in the United States. Numerous anecdotal and clinical reports have demonstrated that central nervous system inflammation, infection, and adverse neurological effects occur as complications of foodborne gastroenteritis. Only a few well-controlled clinical or experimental studies, however, have investigated the neuropathogenesis. The full nature and extent of neurological involvement in foodborne illness is therefore unclear. To our knowledge, this review and commentary is the first effort to comprehensively discuss the issue of FBP induced neurotoxicity. We suggest that much of this information supports the role of a theoretical model, the neuro-immune-endocrine system, in organizing and helping to explain the complex pathogenesis of FBP neurotoxicity.
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Affiliation(s)
- L H Garthoff
- United States FDA, Center for Food Safety & Applied Nutrition, Office of Applied Research and Safety Assessment, Division of Toxicology and Nutrition Product Studies, Neurotoxicology Branch, Laurel, MD 20708, USA.
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Abstract
Bacterial meningitis is the most common serious infection of the central nervous system (CNS) and leads to significant morbidity and mortality. An improved understanding of the pathogenesis of this condition might lead to advances in management and ultimately improve outcome in patients. This article aims to describe currently held concepts about the pathogenesis of bacterial meningitis from nasopharyngeal acquisition, mucosal invasion and entry into the circulation through to the sequelae of subarachnoid space invasion and inflammation, alterations in cerebral blood flow, the blood-brain barrier and intracranial pressure. Finally, the implications of advances in the understanding of the disease process for adjunctive therapy are discussed.
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Affiliation(s)
- D.A.J. Moore
- Department of Infectious Diseases and Microbiology, Imperial College School of Medicine, Hammersmith Hospital, London
| | - J. Cohen
- Department of Infectious Diseases and Microbiology, Imperial College School of Medicine, Hammersmith Hospital, London
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15
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Tsenova L, Bergtold A, Freedman VH, Young RA, Kaplan G. Tumor necrosis factor alpha is a determinant of pathogenesis and disease progression in mycobacterial infection in the central nervous system. Proc Natl Acad Sci U S A 1999; 96:5657-62. [PMID: 10318940 PMCID: PMC21916 DOI: 10.1073/pnas.96.10.5657] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The pathogenesis of tuberculous meningitis, a devastating complication of tuberculosis in man, is poorly understood. We previously reported that rabbits with experimental tuberculous meningitis were protected from death by a combination of antibiotics and thalidomide therapy. Survival was associated with inhibition of tumor necrosis factor alpha (TNF-alpha) production by thalidomide. To test whether cerebrospinal fluid (CSF) levels of TNF-alpha correlated with pathogenesis, the response of rabbits infected in the central nervous system (CNS) with various mycobacterial strains was studied. CNS infection with Mycobacterium bovis Ravenel, M. bovis bacillus Calmette-Guérin (BCG) Pasteur, and M. bovis BCG Montreal were compared. M. bovis Ravenel induced the highest levels of TNF-alpha in the CSF in association with high leukocytosis, protein accumulation, and severe meningeal inflammation. BCG Pasteur had intermediate effects, and BCG Montreal was the least virulent. In addition, M. bovis Ravenel numbers were highest in the brain and CSF and the bacilli also disseminated more efficiently to distant organs, compared with BCG Pasteur and BCG Montreal. In subsequent experiments, rabbits were infected with either recombinant M. bovis BCG Montreal (vector), or BCG Montreal expressing the murine gene for TNF-alpha (BCG mTNF-alpha). BCG Montreal was rendered virulent by the expression of murine TNF-alpha, as demonstrated by high CSF leukocytosis, high protein accumulation, severe meningeal inflammation, persistent bacillary load, and progressive clinical deterioration. Taken together, these results demonstrate that the level of TNF-alpha produced during mycobacterial CNS infection determines, at least in part, the extent of pathogenesis.
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Affiliation(s)
- L Tsenova
- Laboratory of Cellular Physiology and Immunology, The Rockefeller University, 1230 York Avenue, New York, NY 10021, USA
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