Adult meningism and viral meningitis, 1997-2004: clinical data and cerebrospinal fluid cytokines.

Abstract

OBJECTIVE:

Although meningism manifesting acute headache has been observed to be associated with common viral and bacterial infections, its definition and pathogenesis have not been clarified. Clinical findings and cerebrospinal fluid (CSF) cytokines in adult patients with meningism were investigated and compared with those in viral meningitis.

PATIENTS AND METHODS:

Among the adult inpatients in our hospital from 1997 to 2004, 5 with meningism and 17 with viral meningitis were identified according to the criteria described in this study, and their clinical data were analyzed. In the CSF samples of the 5 patients with meningism and the 17 with viral meningitis, the concentrations of interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), interleukin-2 (IL-2), IL-4, IL-6, and IL-10 were determined using a cytometric bead array.

RESULTS:

The five patients with meningism all showed fever and meningeal signs such as severe headache and nuchal stiffness without CSF pleocytosis (<5 cells/mm3). Four patients were associated with herpetic Kaposi's eczema, herpes simplex, or herpes zoster, and all five patients had favorable outcomes. The levels of all CSF cytokines in patients with meningism were below normal values, whereas IFN-gamma and IL-6 in patients with viral meningitis were moderately elevated.

CONCLUSION:

The normal cytokine levels in meningism may possibly reflect the lack of direct viral infection and may be helpful in differentiating both meningism and viral meningitis at an early stage.

• Authors: Masako Nagafuchi, Yoshiro Nagafuchi, Rumi Sato, Toshihiro Imaizumi, Mitsuyoshi Ayabe, Hiroshi Shoji, Takashi Ichiyama
• Journal: Internal medicine (Tokyo, Japan) (Intern Med) Vol. 45 Issue 21 Pg. 1209-12 ( 2006) ISSN: 1349-7235 [Electronic] Japan
• PMID: 17139119 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Cytokines

Topics

• Adult
• Aged
• Cytokines (cerebrospinal fluid)
• Female
• Hospitalization (trends)
• Humans
• Male
• Meningism (cerebrospinal fluid, diagnosis)
• Meningitis, Viral (cerebrospinal fluid, diagnosis)
• Middle Aged