Diagnostic value of Tumor Necrosis Factor - Alpha in cerebrospinal fluid differentiates bacterial from viral meningitis in children

Background: The incidence of pediatric meningitis in Indonesia still arises, with mortality rate between 18-40% and neurological sequelae in developing countries reached between 30-50%. Cytology analysis of cerebrospinal fluid has difficulties in differentiating bacterial meningitis from viral meningitis. Culture, as diagnostic gold standard, only resulted positive in 40-50% of cases. TNF-α cytokine assessment is expected to be able to differentiate bacterial meningitis from viral one in several studies abroad. The value, however, was heterogenic and affected by race, genetic, age and gender.

Objective: To analyze the differences in sensitivity, specificity, positive predictive value, negative predictive value from cut-off value of bacterial and viral meningitis in Indonesian children.

Methodology: Cross-sectional diagnostic study on cerebrospinal fluid samples was conducted in children aged 2 months-18 years from May 2018-June 2019 in Moewardi Hospital, Surakarta.

Results: Out of 46 samples of children with clinical acute meningitis, 23.9% was considered bacterial meningitis, 41.3% viral meningitis, and 30.4% non-meningitis cases. The cut-off value of TNF-α level in bacterial meningitis was 2.61 pg/ml with 90.9% sensitivity, 80% specificity, 58.8% positive predictive value, 96.6% negative predictive value and 0.918 AUC. The cut-off value of TNF-α level in viral meningitis was 1.305 pg/ml with 63.2% sensitivity, 40.7% specificity, 42.9% positive predictive value, 61.1% negative predictive value and 0.434 AUC.

Discussion: The comparison of AUC revealed that TNF-α level in cerebrospinal fluid significantly differed between bacterial and viral meningitis in Indonesian children population. Significant increase of TNF-α level in bacterial meningitis compared to viral meningitis can be used as a diagnostic test of both diseases.

Conclusion: TNF-α cytokine assessment in cerebrospinal fluid can differentiate bacterial meningitis from viral meningitis in Indonesian children.

Keywords: TNF-α, cerebrospinal fluid, bacterial meningitis, viral meningitis

Masayu Lubna Anniazi, Email: lubnamasayu@gmail.com