October 1991

Endotoxin Concentrations in Cerebrospinal Fluid Correlate With Clinical Severity and Neurologic Outcome of Haemophilus influenzae Type B Meningitis

Author Affiliations

From the Departments of Microbiology (Drs Mertsola and Hansen) and Pediatrics (Drs Kennedy, Waagner, Sáez-Llorens, Olsen, and McCracken), University of Texas Southwestern Medical Center, Dallas. Dr Waagner is currently with the University of Texas Health Sciences Center, Houston, and Dr Kennedy is with the University of Alberta (Edmonton) Hospitals.

Am J Dis Child. 1991;145(10):1099-1103. doi:10.1001/archpedi.1991.02160100031019

• 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 1β, 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.

(AJDC. 1991;145:1099-1103)