Cortisol and laboratory indicators of systemic inflammation in case of bacterial purulent meningitis and viral encephalitis in children

Abstract

Pediatric bacterial purulent meningitis (BPM) and viral encephalitis (VE) are significant medical and social problems due to their course severity, high frequency of death cases, and formation of neurologic deficiency at the disease outcome. Activation of hormonal regulation and severity syndrome of systemic inflammatory response are important factors to evaluate the character of BPM and VE course.Objective.To study the level of cortisol and laboratory indicators of systemic inflammation in children with various variants of BPM and VE course depending on the period of the disease (acute period, reconvalescence) to specify their role in the pathogenesis of acute neuroinfections.Object and methods.There were investigated hematological indicators, the level of cortisol, C-reactive protein in blood serum of 60 children, 39 of them had BPM and 21 ones VE. The comparison group included 14 children aged from 1 to 14 years old who were undergoing rehabilitation care due to neurologic problems at the Federal State-Financed Institution Pediatric Research and Clinical Center for Infectious Diseasesunder the Federal Medical Biological Agency.Results.The patients were divided into some subgroups according to the severity of their condition at the moment of hospitalization, i.e. urgent condition or critical condition requiring organ replacement therapy. The maximum increase of cortisol level and laboratory markers of systemic inflammation during the acute period was revealed in case of BPM in comparison with VE with a subsequent normalization to the stage of reconvalescence. Thelevel of cortisol during the acute period of BPM was reliably higher in the subgroup with urgent conditions, whereas in case of VE in the subgroup with critical conditions. There were no significant differences in the laboratory indicators of systemic inflammation response among the subgroups. There was established a correlation interrelation of cortisol level and the content of granulocytes and blood lymphocytes.Conclusion.There were identified characteristic features of cortisol content in children with bacterial and viral neuroinfections depending on the course of the disease.

Diagnostic value of cortisol identification in biological body fluid in case of infectious diseases (literature review)

“…При обследовании пациентов с острыми БГМ различной этиологии установлено, что при пневмококковом менингите показатели кортизола в сыворотке крови не отличались от показателей в группе с менингококковым менингитом (377,4 и 326,5 нмоль/л соответственно), превышая показатели контрольной группы (162,9 нмоль/л) [9]. Ранее проведено исследование динамики уровня кортизола в группах детей с бактериальными и вирусными нейроинфекциями [1]. Максимальный уровень кортизола выявлен в остром периоде БГМ (2150,3 ± 191,2 нмоль/л) по сравнению с вирусным энцефалитом (931,6 ± 225,8 нмоль/л).…”

“…Максимальный уровень кортизола выявлен в остром периоде БГМ (2150,3 ± 191,2 нмоль/л) по сравнению с вирусным энцефалитом (931,6 ± 225,8 нмоль/л). Отмечены различия уровней кортизола у детей с неотложным и критическим состоянием в зависимости от нозологической формы и динамики заболевания [1]. Изучалась взаимосвязь оси НРА с маркерами воспаления и тяжестью заболевания у детей с менингококковой инфекцией [47].…”