Cerebrospinal fluid biomarkers in bacterial meningitis / Biomarker im Liquor cerebrospinalis bei bakterieller Meningitis

Bacterial meningitis (BM) is a serious infectious disease that results in significant morbidity and mortality. Brain damage is mainly caused by the inflammatory reaction to the invading pathogen. This inflammation leads to the release of biomarkers into the cerebrospinal fluid (CSF). Here we review the literature on CSF biomarkers in BM between 1990 and 2008 and discuss it with regard to its clinical relevance to act as a surrogate for diagnostic purposes, estimation of disease severity as well as prediction of treatment response and clinical outcome. We classify recommendations for these markers as levels A–C according to the scheme approved for the European Federation of Neurological Societies guidelines (EFNS). In conclusion, we identified significantly elevated levels of several inflammatory mediators, acute phase proteins, blood-brain barrier associated proteins and markers for oxidative stress and neuronal damage in the CSF of BM patients compared to aseptic meningitis patients and controls. Furthermore, several biomarkers correlated with disease severity, clinical outcome, and response to antibiotic treatment.