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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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