No abstract

Introduction of flow cytometry caused an increase in the investigation of liquor lymphocyte pool phenotype in the case of different brain disorders, including viral and bacterial meningitis, however this type of research in children has been relatively rare. Phenotype and lymphocyte functions are under cytokine control system, therefore detection of interconnections between lymphocyte pool subpopulation composition and cytokine level in blood and liquor of the patients concerns a great interest. The purpose of this research was to study lymphocyte subpopulation composition and the level of cytokines IL-1β, IL-6, IL-8, IL-10, IFNα, IFNγ and IL-4, and also IgG in liquor and blood of children with viral and bacterial meningitis. There was performed blood and liquor investigation in 46 children aged from 1 to 16 years old with viral (n = 35) and bacterial (n = 11) meningitis. Immunophenotyping of blood and liquor cells was performed by the method of flow cytometry with the use of monoclonal antibodies to CD3, CD4, CD8, CD19, CD16, CD56, CD25 and CD95. The content of cytokines was detected in ELISA, and that of IgG — by the method of quantitative immunoturbodimetry. During an acute period of viral meningitis there was detected a decrease in NK portion and activated CD25+ cells in the blood of patients accompanied by the increase in B-lymphocytes number, along with cytokine IFNγ, IL-8 and IL-10 serum level rise. There was determined T-lymphocytes accumulation in liquor with the prevalence of CD4+ Т-cells and, to a lesser degree, CD25+ and CD95+ cells, NK and B-lymphocytes. Intrathecally there was noted the predominance of IL-6 response accompanied by the growth of IL-8 and IL-10 concentration as well. During an acute period of bacterial meningitis there was noted a decrease in percentage of CD3+, CD4+, CD8+ Т-lymphocytes, NK, CD25+ and CD95+ cells, along with, on the contrary, sharp increase in B-cells pool, simultaneously with an expressed system response of IL-8 and IL-10. Liquor T-lymphocyte content was relatively correlated with blood indicators whereas the fraction of NK exceeded it, and B-lymphocyte content was 3–4 times higher than in patients with viral meningitis. There was IL-6, IL-10, IFNγ and IL-4 response intrathecally, and 10-multiply-growth of IgG level. Thus, the redistribution of lymphocyte subpopulations, and system and local cytokine response in children with meningitis have both common and special features depending on the aetiology and severity of disease. Phenotyping of lymphocytes and determination of both cytokines and immunoglobulins simultaneously in two biologic fluid allow to clear up the pathogenetic value of immunologic abnormalities in blood and cerebrospinal fluid of the patients in the aspect of interactions between cell and humoral factors of system and local immune response in neuroinfections of various aetiology.

Pediatric bacterial purulent meningitis (BPM) and viral encephalitis (VE) are significant medical and social problems due to their course severity, high frequency of death cases, and formation of neurologic deficiency at the disease outcome. Activation of hormonal regulation and severity syndrome of systemic inflammatory response are important factors to evaluate the character of BPM and VE course.Objective.To study the level of cortisol and laboratory indicators of systemic inflammation in children with various variants of BPM and VE course depending on the period of the disease (acute period, reconvalescence) to specify their role in the pathogenesis of acute neuroinfections.Object and methods.There were investigated hematological indicators, the level of cortisol, C-reactive protein in blood serum of 60 children, 39 of them had BPM and 21 ones VE. The comparison group included 14 children aged from 1 to 14 years old who were undergoing rehabilitation care due to neurologic problems at the Federal State-Financed Institution Pediatric Research and Clinical Center for Infectious Diseasesunder the Federal Medical Biological Agency.Results.The patients were divided into some subgroups according to the severity of their condition at the moment of hospitalization, i.e. urgent condition or critical condition requiring organ replacement therapy. The maximum increase of cortisol level and laboratory markers of systemic inflammation during the acute period was revealed in case of BPM in comparison with VE with a subsequent normalization to the stage of reconvalescence. Thelevel of cortisol during the acute period of BPM was reliably higher in the subgroup with urgent conditions, whereas in case of VE in the subgroup with critical conditions. There were no significant differences in the laboratory indicators of systemic inflammation response among the subgroups. There was established a correlation interrelation of cortisol level and the content of granulocytes and blood lymphocytes.Conclusion.There were identified characteristic features of cortisol content in children with bacterial and viral neuroinfections depending on the course of the disease.

Objective – to study the dynamics of the level of neuron-specific enolase (NSE) and S-100 protein in blood serum and cerebrospinal fluid in children with various features of viral encephalitis course and outcome and to define their role in diagnostics and prognosis.Material and methods. 48 children aged from 1 month to 15 years were examined. Analysis of the level of NSE and S-100 protein was performed by the method of hardphase immune-enzyme analysis.Results. A reliable increase of the level of S-100 protein in blood serum was identified in comparison with the control group in both acute and reconvalescence periods. During acute period higher values of NSE in blood serum were found in children with herpesvirus encephalitis of various etiologies in comparison with varicella zoster encephalitis, and during reconvalescence period – higher values of S-100 protein. In case of the most severe course of the disease the level of NSE in cerebrospinal fluid was reliably higher in comparison with patients in severe condition. Children with convulsive syndrome demonstrated higher concentration of NSE in cerebrospinal fluid than patients without convulsions. In case of formation of stable neurologic deficiency during the disease outcome there was identified an increase of NSE concentration in blood serum in comparison with the recovered patients. It was also identified that if the values of NSE were >7.0 ng/ml, it was possible to predict unfavourable outcome of viral encephalitis with sensitivity of 61.54% and specificity of 71.43%. The highest values of neuron-specific proteins in blood serum were found in the dead patient with herpes encephalitis.Conclusion. Analysis of NSE and S-100 protein in pediatric viral encephalitis is characterized by diagnostic and prognostic significance, demonstrates their role in pathogenesis and can be used for therapy correction.