[Involvement of soluble mediators of inflammation in the pathogenic agent interaction--immune system in acute bacterial meningitis]

Abstract

Acute Bacterial Meningitis is a medical emergency, which warrants early diagnosis and aggressive therapy, which in most cases must be initiated as an "empirical" treatment. Such an approach needs permanent epidemiological surveillance due to the major variability of the etiological agents depending upon time, geographical areas and demographic characteristics of the population. A program for the surveillance of meningitis is in progress in Romania, but the available clinical inbformation is incomplete and not well documented by paraclinical data, poorly reflecting the real incidence of the disease. The specific anatomic localization of the disease has major influences on the antiinfectious immune response. Inflammation is involved in the disease pathogenesis, especially in promotion and evolution of neurological sequelae (neuronal demyelinisation and degeneration) even in case of pathogen clearance following antimicrobial therapy. Activation of the immune response in a immunologically "privileged "region can lead to the break of tolerance and induction of autoimmunity (neuronal degenerescence). On the other hand, an efficient immune response is necessary for the clearance of pathogenic agents. A detailed investigation of the interaction between pathogenic agents and the immune system in relation to the particular meningeal localization and also a study on the involvement of soluble mediators of inflammation (cytokines, chemokines) in the pathogenesis of meningitis might prove useful for differential diagnosis (viral or "aseptic" meningitis) and also for elucidating the mechanisms which that underlie the disease pathogenesis/neurological complications.