Introduction

Central nervous system infections (CNS) are life-threatening diseases, with meningitis being the most common. Viral infections are usually self-limiting diseases but bacterial pathogens are associated with higher mortality rates and persistent neurological sequelae. We aimed to study the role of IL-6, IL-8, IL-10, IL-12(p40), TNF-α cytokines, classical cerebrospinal fluid (CSF) parameters, and serum C-reactive protein levels (CRP) for discriminating bacterial from viral central nervous system infections.

Material and methods

This prospective study included 80 patients with clinical signs and abnormal cerebrospinal fluid laboratory findings typical for neuroinfection admitted to St. George University Hospital-Plovdiv. Routine methods such as direct microscopy, culturing and identification were used for microbiological analysis as well as latex-agglutination test and multiplex PCR. Cytokines' concentrations were measured by ELISA. CRP and CSF parameters were collected from the patients' medical records.

Results

We observed the highest discriminatory power among cytokines for cerebrospinal IL-12(p40) (AUC = 0.925; p = 0.000). CSF protein levels were the best predictor for bacterial neuroinfection (AUC = 0.973; p = 0.000). The AUC for the serum CRP as a stand-alone biomarker was estimated to be 0.943. The discriminatory power can be increased up to 0.995 (p = 0.000) when combining cerebrospinal fluid IL-12(p40) and serum CRP, with an optimal cut-off value of 144 (Sensitivity 100%; Specificity 90.9%).

Conclusion

The combined testing of CSF IL-12(p40) and serum CRP is associated with the highest diagnostic accuracy.

中文翻译：

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联合检测脑脊液 IL-12 (p40) 和血清 C 反应蛋白作为急性细菌性神经感染的可能鉴别指标

介绍

中枢神经系统感染 (CNS) 是威胁生命的疾病，其中脑膜炎最为常见。病毒感染通常是自限性疾病，但细菌病原体与较高的死亡率和持续的神经系统后遗症有关。我们旨在研究 IL-6、IL-8、IL-10、IL-12(p40)、TNF-α 细胞因子、经典脑脊液 (CSF) 参数和血清 C 反应蛋白水平 (CRP)区分细菌和病毒中枢神经系统感染。

材料与方法

这项前瞻性研究包括 80 名在普罗夫迪夫圣乔治大学医院收治的具有典型神经感染临床症状和脑脊液实验室检查结果异常的患者。常规方法如直接显微镜检查、培养和鉴定用于微生物分析以及乳胶凝集试验和多重PCR。通过ELISA测量细胞因子的浓度。从患者的医疗记录中收集 CRP 和 CSF 参数。

结果

我们观察到细胞因子对脑脊液 IL-12(p40) 的最高区分能力（AUC = 0.925；p = 0.000）。脑脊液蛋白水平是细菌性神经感染的最佳预测指标（AUC = 0.973；p = 0.000）。血清 CRP 作为独立生物标志物的 AUC 估计为 0.943。结合脑脊液 IL-12(p40) 和血清 CRP 时，鉴别力可提高至 0.995 (p = 0.000)，最佳截止值为 144（灵敏度 100%；特异性 90.9%）。

结论

CSF IL-12(p40) 和血清 CRP 的联合检测与最高的诊断准确性相关。