1338. Decrease in Cerebrospinal Fluid Cathelicidin During Bacterial Meningitis in Children Correlates With Improved Outcome
Session: Oral Abstract Session: CNS Infections
Saturday, October 10, 2015: 8:30 AM
Room: 7--AB

Cathelicidin (LL-37) is an antimicrobial peptide, which plays a role in the innate host defense. It is upregulated in the presence of vitamin D and elevated concentrations have been reported in cerebrospinal fluid (CSF) from patients with bacterial meningitis (BM). The aim of this study was to assess CSF LL-37 concentrations in childhood BM on admission and during antimicrobial treatment, and to investigate whether they predict the outcome in BM.


CSF samples were collected on admission (CSF1) and 12-24 hours later (CSF2) from patients with BM during 1996-2003 in the Dominican Republic (n=101, median age 8 months); 24 had S. pneumoniae, 36 H. influenzae, 7 N. meningitidis, and in 34 the etiology remained unknown. CSF LL-37 concentrations were measured by ELISA: the results are given as medians with interquartile range (IQR). LL-37 concentration and the LL-37 CSF2/CSF1 -ratio were compared with biomarkers associated with inflammation and clinical outcome using Spearman and Mann-Whitney tests as appropriate.


LL-37 concentrations in CSF1 and CSF2 were 25.7 (IQR 91.5, N=91) ng/mL and 9.5 (IQR 43.4, N=77) ng/mL, respectively. They did not vary according to etiology, age, or serum vitamin D concentration, (p>0.05), but correlated with CSF white cell count and protein levels (in CSF1, Rho 0.528 and 0.618, p<0.0001 for each, respectively). A lower LL-37 CSF2/CSF1–ratio correlated with a higher (=better) Glasgow Outcome Scale (GOS) score (Rho, -0.36; p=0.009) and a decrease in LL-37 concentration correlated with optimal recovery (GOS=5, p=0.046). No similar association was seen with the change in CSF white cell count or protein level.


Our results suggest that CSF LL-37 may be used as a novel biomarker of the inflammatory process in BM. A decrease in CSF LL-37 in response to treatment likely signaled a more rapidly limiting disease process and was associated with a better outcome in childhood BM.

Okko Savonius, MD1,2, Otto Helve, MD, PhD1,2, Irmeli Roine, MD, PhD3, Sture Andersson, MD, PhD1,2, Josefina Fernandez, MD, PhD4, Heikki Peltola, Professor1,2 and Tuula Pelkonen, MD, PhD1,2, (1)Children’s Hospital, Helsinki University Central Hospital, Helsinki, Finland, (2)Faculty of Medicine, University of Helsinki, Helsinki, Finland, (3)Faculty of Medicine, University Diego Portales, Santiago, Chile, (4)Clínica Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic


O. Savonius, None

O. Helve, None

I. Roine, None

S. Andersson, None

J. Fernandez, None

H. Peltola, None

T. Pelkonen, None

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