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clinmed/2000060004v1 (December 29, 2000)
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INTRATHECAL IMMUNOGLOBULIN PRODUCTION IN CASES OF CHILDHOOD BACTERIAL MENINGITIS
Ismail H. KARA, Bünyamin DIKICI, Mehmet BOSNAK, Fuat GÜRKAN, and Kenan HASPOLAT
Objectives: The aim of this study was to evaluate the IgG, IgM and IgE indices of different types of childhood’s bacterial meningitis.
Background: This prospective cohort study was performed in Dicle University, Paediatric Clinic of Medical Faculty between August 1996 and February 1997. There were 18 patients with bacterial meningitis including eight patients with meningococcal meningitis (MM), five patients with purulent (PM) and five patients with tuberculous (TBM) in the studied group.
Methods: IgG index was calculated by formula of Link and Tibbling (IgG ratio/albumin ratio of CSF to serum). (You can compare levels of Ig’s and clinical presentations and outcomes)
Results: Age of patients ranged between 11 and 156 months with a mean of 65±49 months. One of patients with TBM was exitus; shunting operation was performed to three of the rest. Neurological sequelae developed in all patients with TBM, and in 2 patients with PM. Temporary visual impairment was determined in only one patient with MM. The mean IgG, IgM and IgE indices in our cases with TBM were 1.2, 0.8 and 6.9, respectively. The mean CSF IgG and CSF IgE indices were slightly higher in patients with TBM than in other subjects (p<0.01 and p=0.01, respectively). CSF of patients with PM showed significantly high titres of circulating IgE antibodies than in other subjects (p=0.001).
Conclusions: The patients with CNS inflammation, especially TBM, had elevated IgG and IgE indices compared to other groups. BBB (brain-blood barrier) damage was most severe in cases of TBM in our series. Moreover, CSF of patients with PM showed significantly high titres of circulating IgE antibodies than in other subjects.
Key Words: Blood-brain barrier, IgG, IgM and IgE indices, meningitis.