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

Mertsola, Jussi; Kennedy, William A.; Waagner, David C.; Sáez-Llorens, Xavier; Olsen, Kurt; Hansen, Eric J.; McCracken, George H.

doi:10.1001/archpedi.1991.02160100031019

Cited by 20 publications

(18 citation statements)

References 32 publications

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“…For example, it has long been recognised that the inhibition of protein synthesis can accentuate this process, presumably as a consequence of an altered composition of the outer membrane. [19] Specific uncertainties inherent in the separation of free from bound endotoxin have previously been raisedJ2,26] However, a more critical issue is that where levels of endotoxin have been correlated with adverse outcome, in clinical settings such as sepsis [5,27] and meningitis [14] or in animal models, [28,29] it was levels of total (i.e. unfractionated) endotoxin that were measured.…”

Section: The Concept Of Free Endotoxinmentioning

confidence: 99%

Antibiotic-Induced Release of Endotoxin A therapeutic Paradox

Hurley

1995

Drug Safety

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There is clear experimental evidence that antibiotics increase the bioavailability of endotoxin from Gram-negative bacteria. In this review, data for 2 variables, level of endotoxin and level of bacteria, at the time point closest to 2 hours post-antibiotic exposure were abstracted as a change from baseline readings from each available study, to enable presentation in a graphical overview. This overview indicates that the phenomenon is not limited to beta-lactam agents nor is it apparent only for the more rapidly bactericidal agents. However, evidence that this phenomenon is of clinical importance is scant. With the Jarisch-Herxheimer reaction (JHR), there is clear evidence for an acute deterioration with the initiation of antibiotic therapy and yet uncertainty as to the nature of the bacterial mediator(s) of this reaction. There is no evidence to support the commonly stated concern that therapy with antibiotics with a more rapid bactericidal action may result in the sudden lysis of bacteria with the release of cell wall components and cause a deterioration that might be avoidable through the use of antibiotics with a slower time course of action.

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Section: The Concept Of Free Endotoxinmentioning

confidence: 99%

Antibiotic-Induced Release of Endotoxin A therapeutic Paradox

Hurley

1995

Drug Safety

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“…On the contrary, children with meningitis aged over 18 months fell into two approximately equal groups with differing levels of convalescent-phase antibody. The difference in age-adjusted mean antibody levels between children with epiglottitis and meningitis in this study was at least partly attributable to a sub-group of poorly responding children with meningitis who may have had a more severe illness than the others, as indicated by lower CSF glucose [26][27][28][29] and a longer duration of fever. Alternatively, the reduction in convalescent-phase antibody levels in this group may reflect complexing of antibody within immune complexes.…”

Section: Discussionmentioning

confidence: 97%

Differing antibody responses toHaemophilus influenzaetype b after meningitis or epiglottitis

et al. 1996

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SUMMARYTwo common forms of invasive disease due to Haemophilus influenzae type b (Hib) are epiglottitis and meningitis. It is not known why some children develop epiglottitis and others meningitis. To examine the hypothesis that epiglottitis occurs in children who may have been previously exposed to Hib, and who would therefore exhibit a more vigorous antibody response in convalescence, we measured levels of antibody to Hib capsule in 92 children. Geometric mean convalescent-phase IgG, IgA, IgM and total antibody levels were significantly higher in 45 children with epiglottitis than in 47 with meningitis, even after adjustment for age differences (mean total antibody, 95% confidence intervals: meningitis 0-38, 034-043; epiglottitis: 2 25, 2'0-2 54 /sg/ml). However, contrary to previous reports, a poor antibody response was only observed in a minority of children with meningitis; the antibody response of the majority was indistinguishable from that observed in children with epiglottitis.

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“…Strategies seeking to reduce the concentration of proinflammatory bacterial products appear particularly promising since they do not inhibit the immune response of the host such as corticosteroids. In children with H. influenzae meningitis the concentrations of endotoxin in CSF is correlated with the incidence of long-term neurological sequelae [10]. In the rabbit intracisternal injection of a recombinant N-terminal fragment of bactericidal/permeability-increasing protein (rBPI23), which binds endotoxin, decreased parameters of subarachnoid space inflammation induced by lipopolysaccharides from E. coli [7].…”

Section: Discussionmentioning

confidence: 99%

Streptococcal meningitis: effect of CSF filtration on inflammation and neuronal damage

Schmidt

Stuertz

Trostdorf

et al. 1999

Journal of Neurology

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The effect of CSF filtration on inflammation and neuronal damage was studied in experimental Streptococcus pneumoniae meningitis. New Zealand white rabbits received either antibiotic therapy alone (ceftriaxone i.v., 20 mg/kg bolus, 10 mg/kg maintenance dose; n = 10) or ceftriaxone plus CSF filtration (n = 11) 12 h after intracisternal infection. Immediately after the onset of antibiotic therapy 300 microliters cisternal CSF was removed, passed through a miniaturized CSF-1 filter at a constant flow of 20 microliters/min, and then reinjected. This procedure was repeated six times at intervals of 20 min. Antibiosis plus CSF filtration caused a transient reduction in CSF bacterial titers and leukocyte counts compared with antibiosis alone (P = 0.04 and 0.02 5 h after initiation of therapy). CSF lipoteichoic acid concentrations were not reduced. The concentration of neuron-specific enolase in CSF and the density of apoptotic neurons in the dentate gyrus were almost equal 12 h after the onset of treatment. Adjuvant CSF filtration accelerated the elimination of viable bacteria from CSF in comparison to antibiotic treatment alone. Parameters of neuronal destruction, however, were not reduced.

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

Cited by 20 publications

References 32 publications

Antibiotic-Induced Release of Endotoxin A therapeutic Paradox

Antibiotic-Induced Release of Endotoxin A therapeutic Paradox

Differing antibody responses toHaemophilus influenzaetype b after meningitis or epiglottitis

Streptococcal meningitis: effect of CSF filtration on inflammation and neuronal damage

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