Cerebrospinal fluid concentrations of soluble tumor necrosis factor receptor in bacterial and aseptic meningitis.

Soluble tumor necrosis factor receptor (sTNF-R) is the natural homeostatic regulator of the action of TNF-alpha. The level of sTNF-R reflects the true biologic activity of TNF-alpha. We investigated whether sTNF-R increases in CSF during patients' acute stage of bacterial and aseptic meningitis by measuring p60 sTNF-R in CSF by a sandwich enzyme immunoassay. The concentrations of sTNF-R were significantly higher in the CSF of children with bacterial meningitis than in the CSF of those with aseptic meningitis or of control subjects. The patients with bacterial meningitis who died or had severe neurologic sequelae had higher sTNF-R levels than those who survived. Our findings suggest that the sTNF-R level in CSF during acute bacterial meningitis is important for predicting neurologic sequelae.