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

Jussi Mertsola, MD; William A. Kennedy, MD; David Waagner, MD; Xavier Sáez-Llorens, MD; Kurt Olsen; Eric J. Hansen, PhD; George H. McCracken Jr, MD
Am J Dis Child. 1991;145(10):1099-1103. doi:10.1001/archpedi.1991.02160100031019.
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• 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)

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