A study of cytokines in tuberculous meningitis: Clinical and MRI correlation

There is paucity of studies on cytokines in tuberculous meningitis (TBM) and their relation with clinical and radiological changes; therefore this study was undertaken. 16 TBM patients diagnosed on the basis of clinical, CSF and radiological criteria were included. They were subjected to TNF-α, IL-6, IL-8, IL-10, IL-1β, and IL-12p70 estimation in CSF. The cytokine levels were also estimated in 10 controls. Initial clinical examination, stage of TBM and MRI findings (infarct, hydrocephalus, tuberculoma and exudates) were recorded. The patients were treated with 4 drugs antitubercular (RHZE) therapy and after 3 months clinical examination, cytokine levels, and radiological studies were repeated. Outcome was defined by Barthel index score at 3 months into poor, partial and complete recovery. The patient's age ranged between 10 and 50 years, 5 were females. At 3 months, all the patients were clinically followed up and 14 underwent repeat MRI. 10 patients improved, 1 remained stable and 5 deteriorated. There was worsening with respect to tuberculoma in 3, infarction in 2 and exudate in 1 patient. TNF-α was expressed in 32% patients, IL-6, IL-10, IL-1β and IL-8 were significantly expressed in patients and declined after 3 months following treatment. The cytokine levels did not correlate with stage of meningitis, outcome and radiological deterioration or improvement.

Research highlights▶ TNF-α was expressed in 32% patients with TBM, IL-6, IL-10, IL-1β and IL-8 were significantly expressed in patients compared to controls and declined after 3 months of antitubercular therapy. ▶ Levels of IL-6 was increased in patients who had worsening of exudates and tuberculoma. ▶ The cytokine levels however did not significantly correlate with stage of meningitis, outcome and radiological deterioration or improvement.