Endotoxin concentrations in cerebrospinal fluid correlate with clinical severity and neurologic outcome of Haemophilus influenzae type B meningitis
J. Mertsola, W. A. Kennedy, D. Waagner, X. Saez-Llorens, K. Olsen, E. J. Hansen and G. H. McCracken Jr
Department of Microbiology, University of Texas Southwestern Medical Center, Dallas 75235-9063.
Endotoxin concentrations were measured in paired samples of cerebrospinal
fluid from 38 patients with Haemophilus influenzae type b meningitis. On
admission, the median concentration of endotoxin in cerebrospinal fluid was
104 ng/mL and decreased rapidly in follow-up samples. From 17 to 48 hours
after admission, 50% of the patients had concentrations of less than 1
ng/mL. Endotoxin concentrations correlated significantly with
concentrations of interleukin 1 beta, protein, and glucose in cerebrospinal
fluid, duration of secondary fever, and neurologic abnormalities during
hospitalization and on follow-up examinations. Twenty-eight percent of
patients with endotoxin concentrations of 100 ng/mL or more on admission
had long-term complications, compared with none of those with lower
endotoxin concentrations (relative risk, 2.31; 95% confidence interval,
1.53 to 3.48). These results indicate that quantitation of endotoxin in
cerebrospinal fluid could be a valuable aid in identifying those children
at increased risk of complications during Haemophilus influenzae type b
meningitis and provide additional evidence that the Haemophilus influenzae
type b meningitis lipo-oligosaccharide is important in the pathogenesis of
meningitis.
