[Nitric oxide (NO) in children with meningitis].

Twenty seven children with a documented bacterial (BM)-, 73 with viral (mumps and enteroviral) meningitis and 51 controls were included. CSF white blood cell counts, glucose and protein concentrations were determined routinely. CSF nitrite and nitrate levels (the stable degradation product of NO) were determined by a modified Griess reaction. The mean +/- levels of nitrite and nitrate in CSF on admission were higher in patients with BM in comparison with controls and in children with viral meningitis. In 10 patients dexamethasone therapy was started about 10 minutes before the first antibiotic dose and given every 12 hours of 0.4 mg/kg for 2 days. At 24 to 48 hours those who received dexamethasone therapy had a significantly lower mean +/- SD CSF nitrite concentration compared with that in non-steroid treated patients. In all patients with meningitis a significant positive correlation was found between CSF nitrite and CSF granulocyte counts and also CSF protein concentration. Increased production of NO in the CSF compartment during the acute phase of BM may contribute to the inflammatory process and tissue injury. Dexamethasone therapy administered before the first parenteral antibiotic dose reduces the production of NO in the CSF during BM.