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CSF Level of Interleukin-l Beta in Neonatal Cases of Septic Meningitis: Effect of Dexamethasone Therapy .
Amal Balbaa*, Azza Badr*, Hamida Gohar* and Safinaz El-Maraghi**
Medical Microbiology & Immunology* and Pediatrics** Departments, Faculty of Medicine, Cairo University.

Bacterial meningitis in the newborn is a serious disease because of its high mortality and the sequelae associated with the disease. The main patho-physiologic events in bacterial meningitis are due to the release of bacterial products that induce the production of potent pro-inflammatory cytokines (e.g. TNF- a and IL-lb). We conducted this study to compare the levels of CSF IL-lb in neonates suffering from bacterial meningitis and neonates with septicemia due to other septic conditions and to assess the role of dexamethasone in suppressing these levels and improving the outcome of the decrease. One hundred and twenty septic neonates were studied. Fifty (41.6%) of them were proven to be meningitic by CSF culture and/or latex agglutination. Group B streptococci were the most frequent (26%) causative organism followed by E. coli (24%), klebsiella (16%) and Staphylococcus aureus (12%). Out of the meningitic cases (group I), 25 neonates (group I-A) were chosen randomly to receive dexamethasone beside the antibiotic and supportive therapy while the remaining cases received only antibiotics and supportive therapy (group I-B). A highly significant difference (P < 0.001) in the CSF IL-lb concentration was found between meningitic (group I) and septic (group II) cases with a mean value of 376.2 pg/ml and 15.16 pg/ml, respectively. Marked drop (P < 0.001) in the level of IL-lb was observed in group I-A after treatment (mean value 397.3 pg/ml before treatment and 9 pg/ml after treatment) . Although the drop in IL-lb level in group I-B was significant (P < 0.01), yet it was less dramatic (mean value 355 pg/ml before treatment and 104.4 pg/ml after treatment) than group I-A. A better survival rate was found for the dexamethasone treated (76%) than untreated (48%) groups of patients (p < 0.05). These findings suggest that IL-lb could be considered as a valid diagnostic as well as prognostic predictor of neonatal bacterial meningitis. The dexamethasone administration in neonatal meningitis as an adjuvant therapy, decreased the CSF level of IL-lb dramatically and in turn improved the outcome of the disease.

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Copyright 2002 Egyptian Association of Immunologists .
Last modified: January 21, 2003 .