muramidase and Meningitis

Topics: Adult; Diagnosis, Differential; Humans; Hydrocephalus; Magnetic Resonance Imaging; Male; Meningitis; Muramidase; Peptidyl-Dipeptidase A; Radiography; Sarcoidosis

Total neopterin (T-N), a by-product in the biopterin biosynthesis and an indicator of activation of the cellular immune system, and total biopterin (T-B) levels in cerebrospinal fluid (CSF), were measured in patients with various inflammatory neurological diseases and Parkinson's disease, and the following results were obtained. (1) In patients with neuro-sarcoidosis, neuro-Behçet's disease and meningitis, CSF T-N levels were markedly elevated in the exacerbation or acute stages of their neurological symptoms and remarkably decreased in the remission or chronic stages. In the neuro-sarcoidosis and neuro-Behçet's disease patients, however, CSF T-B levels showed no substantial change. (2) There was a significant positive correlation between CSF T-N levels and CSF/serum albumin ratios only in the meningitis patients. However, increases of CSF T-N levels were not associated with those of plasma T-N levels. (3) In the Parkinson's disease patients, CSF T-N levels remained normal, although CSF T-B levels significantly decreased. (4) A gradient for the CSF T-N value (lumbar greater than ventricular CSF), being reverse to the CSF T-B value, was observed. These results indicate that the significance of CSF T-N is quite different from CSF T-B, and that CSF T-N appears to be a valuable biochemical marker for evaluating the activity of inflammation within the central nervous system. Its measurement seems useful for therapeutic monitoring, especially of patients showing the chronic exacerbating-remitting course.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Behcet Syndrome; Biopterins; Female; Humans; Immunity, Cellular; Male; Meningitis; Muramidase; Neopterin; Nervous System Diseases; Sarcoidosis

Lysozyme (LZM), immunoglobulin M (IgM) and C-reactive protein (CRP) levels were determined in cerebrospinal fluid (CSF) from patients classified on the basis of clinical and laboratory findings into three groups: bacterial meningitis (n = 33), lymphocytic meningitis (n = 21) and controls (n = 54). IgM and CRP levels were determined by enzyme-linked immunosorbent assay (ELISA) and LZM by the lysoplate method. Discriminant analysis demonstrated that 93.94% (31/33) and 96.97% (32/33) of patients with bacterial meningitis were correctly classified on the basis of CSF determinations of IgM and LZM, respectively. However, the measurement of CRP levels in CSF correctly classified 100% of these patients (33/33), thus representing a useful additional marker for the screening of bacterial meningitis. Moreover, no more than 4% (3/75) of patients were incorrectly classified as belonging to the bacterial group on the basis of the CRP test. Thus, CRP titres less than or equal to 80 identify cases belonging to one of the non-bacterial groups, whereas titres greater than or equal to 640 classify the bacterial group, with a very low chance of misclassification. The authors recommend that CSF IgM or LZM levels be also measured for patients with CSF CRP titres of 160 and 320, for a more accurate diagnosis. The probability of these cases being of bacterial aetiology, as calculated from the combined results of these measurements, is presented.

Topics: Adolescent; Adult; Aged; C-Reactive Protein; Child; Child, Preschool; Diagnosis, Differential; Discriminant Analysis; Humans; Immunoglobulin M; Infant; Meningitis; Meningitis, Bacterial; Middle Aged; Muramidase

Three variants of the immunoenzymometric assay of human lysozyme with HRP-labeled antibodies were compared. The highest sensitivity (with a detection limit of 0.2 micrograms lysozyme/L) was achieved by a one-step assay lasting 2 h. Between-batch precision for the techniques was 6-11%. Lysozyme reference values were determined in serum, cerebrospinal fluid and urine. In serum they are age-dependent and in urine sex-dependent when related to creatinine excretion. Serum lysozyme is increased in only 57% of the patients with active rheumatoid arthritis and is also unreliable for indicating remission. In Crohn's disease the serum lysozyme reflects activity better, but it does not exceed the diagnostic value of alpha-1-acidic glycoprotein (orosomucoid). The lysozyme quantification in cerebrospinal fluid is useful in distinguishing between viral or bacterial meningitis.

Topics: Acute Disease; Adolescent; Adult; Aged; Aging; Arthritis, Rheumatoid; Body Fluids; Clinical Enzyme Tests; Crohn Disease; Diagnosis, Differential; Enzyme Stability; Evaluation Studies as Topic; Humans; Immunoenzyme Techniques; Infant, Newborn; Meningitis; Meningitis, Viral; Middle Aged; Muramidase; Nervous System Diseases; Reference Values

Cerebrospinal fluid lysozyme (CSF-LZM) concentrations were determined in 62 controls, 28 viral meningitis and 22 bacterial meningitis, as compared to CSF lactic acid routinely used. CSF-LZM measurement was performed by a rapid turbidimetric assay which required 50 microliters CSF only. The mean CSF-LZM concentration of the control group was 0.23 mg/l, the highest value being 0.65 mg/l. The mean LZM levels in viral meningitis were 1.10 mg/l, never exceeding 3 mg/l. The range of pretreatment LZM levels in bacterial meningitis was 7.2 to 65 mg/l and above 3 mg/l in all cases 48 h after treatment. On the 6th day after admission, 12 of 16 samples showed abnormal values. The CSF-LZM assay seems to be of more value than that of lactic acid. Thus, before treatment, LZM concentrations were 10 to 100 fold higher than that of the normal values, with persistent high levels on the 2nd and even on the 6th day of treatment (whereas lactic acid values were all normal on day 6).

Topics: Analysis of Variance; Bacterial Infections; Child; Child, Preschool; Humans; Infant; Lactates; Lactic Acid; Meningitis; Muramidase; Photometry; Protein C; Virus Diseases

A turbidimetric technique has been adapted to yield maximum sensitivity for the measurement of lysozyme in cerebrospinal fluid. One hundred and ninety-eight patients were studied over a total period of 9 months using this technique. In addition to the considerably elevated levels known to occur in cases of bacterial and fungal meningitis, increased activity was also demonstrated in cases of subarachnoid haemorrhage and in certain inflammatory conditions. Normal or marginally increased levels were seen in cases of viral meningitis and encephalitis.

Topics: Bacterial Infections; Encephalitis; Humans; Meningitis; Meningitis, Viral; Muramidase; Nephelometry and Turbidimetry; Nervous System Diseases

Meningococci and Haemophilus influenzae may invade the subarachnoid space during the bacteriaemic phase without impairment of the blood-CSF barrier and in the absence of any leucocyte reaction. In pneumococcal meningitis the CSF may also contain less than 100 cells/microliter despite the presence of "pure bacterial cultures", but the barrier is completely broken when the serum/CSF concentration ratio is below 10. A clinical analysis of eight patients with fewer than 100 cells/microliter revealed that the first symptoms of meningitis appeared at least 3 days prior to the diagnostic lumbar puncture. There was a strong neutrophilic reaction in the blood with a prevalence of juvenile forms in most cases, indicating intact antibacterial defence mechanisms. Within 24 h after the start of antibiotic therapy the cell number rose above 2000/microliter accompanied by disappearance of pneumococci. Six of the eight patients died. In three cases autopsy revealed thick layers of pus over the convexities, indicating a compartmental separation of the ventricles and the spinal subarachnoid space. In one case of late diagnosed bacterial meningitis with a pleocytosis of 430/microliter the CSF lysozyme level was seven times higher than compatible with this cell number. Hyperphagocytosis and cellular disintegration is thought to cause the leucopenia within the spinal CSF compartment. "Apurulent bacterial meningitis" can be seen as a disease entity that is a diagnostic pitfall and also a prognostic sign.

Topics: Adult; Aged; Bacterial Infections; Blood-Brain Barrier; Female; Glucuronidase; Humans; Leukocyte Count; Leukopenia; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Listeria; Meningitis, Pneumococcal; Middle Aged; Muramidase; Prognosis

The significance of the measurement of lactate, lysozyme and PHI in CSF for differential diagnosis of meningitis was examined in 58 cases of viral, 36 of bacterial and 5 of tuberculous etiology. In the early phase of the illness CSF lactate was found to be the most sensitive parameter for distinction of viral from bacterial or tuberculous meningitis respectively. Except for one case CSF lactate exceeded 3.8 mmol/l in all cases of bacterial etiology, whereas this value was never reached in any case of viral meningitis. While lactate concentration was maximal on the day of admission and declined continuously thereafter, PHI activity reached its maximum on the third day after beginning of the therapy. At this time all patients with a bacterial or tuberculous meningitis had PHI activities about 50 U/l. This value wasn't exceeded in any case of viral meningitis. In a few cases some days after onset of therapy a distinction of bacterial meningitis from viral forms was still possible by PHI determination but not by lactate measurement. Determination of lysozyme also could be helpful in the later phase of the disease.

Topics: Bacterial Infections; Cryptococcosis; Diagnosis, Differential; Glucose-6-Phosphate Isomerase; Humans; Lactates; Lactic Acid; Meningitis; Meningitis, Viral; Muramidase; Mycoplasma Infections; Tuberculosis, Meningeal

Topics: Adolescent; Bacterial Infections; Child; Child, Preschool; Clinical Enzyme Tests; Humans; Infant; Meningitis; Muramidase

The determination of lysozyme has been shown to be more relevant than assumed until now. It can be used as a marker in the therapy of acute and chronic urinary tract infections. The determination of lysozyme in cerebro spinal fluid and blood serum are helpful to differentiate between bacterial and aseptic meningitides or infections. Elevated fecal lysozyme excretion in adolescents are an indicator for a chronic inflammatory bowel disease. Control of fecal lysozyme excretion can be used as a marker for a relapse and to monitor therapeutic efficiency in patients with inflammatory bowel disease. A consistent high level of fecal lysozyme excretion in adults over the age of 40 is an indicator for possible colorectal tumors and warrants further thorough investigation.

Topics: Adolescent; Adult; Bacterial Infections; BCG Vaccine; Colonic Neoplasms; Crohn Disease; Diagnosis, Differential; Feces; Humans; Macrophages; Meningitis; Monocytes; Muramidase

Topics: Diagnosis, Differential; Humans; Macrophages; Meningitis; Muramidase; Tuberculosis, Meningeal

Topics: Bacterial Infections; Child; Colitis, Ulcerative; Crohn Disease; Diagnosis, Differential; Feces; Hepatitis A; Humans; Meningitis; Meningitis, Aseptic; Muramidase; Urinary Tract Infections; Virus Diseases

Lysozyme was determined with a turbidimetric assay in blood and cerebrospinal fluid. There were 17 children without CNS-disease, 30 patients with viral meningitis, 5 patients with encephalitis, 3 with symphatetic meningitis, 3 with Guillain Barré syndrome, 25 children with bacterial meningitis, 1 patient with tuberculous meningitis and two with intracranial tumors. The lysozyme level was below 0.5 microgram Hl/ml in patients without CNS-disease, in viral and symphatetic meningitis, Guillain Barré syndrome and encephalitis. Elevated lysozyme levels were found in bacterial meningitis, in the one case with tuberculous meningitis and in brain tumors (Ependymoma and Medulloblastoma). In our opinion the lysozyme level is a valuable aid in the differentiation of viral meningitis to bacterial meningitis.

Topics: Cerebellar Neoplasms; Cerebrospinal Fluid; Child; Ependymoma; Humans; Medulloblastoma; Meningitis; Meningoencephalitis; Muramidase; Tuberculosis, Meningeal

C.S.F. lactate- and lysozyme concentrations were determined in 74 children with bacterial and aseptic meningitis, combined with other laboratory findings (white-cell count, differential blood count, total protein, glucose). Lactate and lysozyme concentrations proved to be best for the differentiation between bacterial and aseptic meningitis.

Topics: Adolescent; Bacterial Infections; Blood Glucose; Blood Proteins; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Lactates; Leukocyte Count; Meningitis; Muramidase

We describe a simple, rapid, sensitive, and highly reproducible assay for lysozyme, with use of concentrated cell suspensions of Micrococcus lysodeikticus in Tris-buffered glycerol/water (40/60 by vol), pH 7.5. Stored at -20 degrees C, the cells' susceptibility to lysozyme remains unaltered over long periods. Almost identical concentration curves were obtained with different aliquots of the same preparation during eight months. Lysozyme activity was reflected in the decrease in absorbance of the reaction mixture after incubation for 15 min at 37 degrees C. Concentrations of egg-white lysozyme as low as 0.02 mg/L can be accurately assayed.

Topics: Biological Assay; Humans; Kinetics; Leukemia; Meningitis; Meningitis, Viral; Micrococcus; Muramidase

Topics: Female; Herpes Simplex; Humans; Meningitis; Meningoencephalitis; Middle Aged; Muramidase

Topics: Humans; Meningitis; Meningoencephalitis; Muramidase

Topics: Clinical Enzyme Tests; Diagnosis, Differential; Humans; Meningitis; Meningitis, Aseptic; Meningitis, Viral; Muramidase

Lysozyme is absent from normal cerebrospinal fluid (C.S.F.) and in C.S.F. from children with viral meningitis. Appreciable amounts of lysozyme were noted in C.S.F. from children with bacterial meningitis (0.23 +/- 0.14 mg/100 ml) and cerebral convulsions (0-0.82 mg/100 ml). The C.S.F.-lysozyme content is a sensitive indicator for bacterial meningitis and important in the differential diagnosis between viral and bacterial meningitis. The beta2-microglobulin content of C.S.F. in healthy children was 0.11 +/- 0.05 mg/100 ml; in children with viral meningitis 0.20 +/- 0.06 mg/100 ml and in children with bacterial meningitis 0.44 +/- 0.17 mg/100 ml. Children with cerebral convulsions had also a rise in C.S.F. beta2-microglobulin.

Topics: Adolescent; beta 2-Microglobulin; Beta-Globulins; Cerebrospinal Fluid Proteins; Child; Child, Preschool; Humans; Infant; Meningitis; Meningitis, Viral; Muramidase; Seizures; Seizures, Febrile

The bacteriolytic activity of 153 samples of cerebrospinal fluid (CSF) from patients with various diseases was measured by determining the ability of the CSF to cause lysis of a suspension of killed cells of Micrococcus lysodeikticus. Normal CSF did not show significant bacteriolytic activity. A high activity was found in patients with bacterial meningitis (mainly meningococcal), only to some extent correlated with the protein and cell content of the CSF. Slight elevation of protein and cell content of CSF in patients with diseases other than bacterial meningitis was not accompanied by significant bacteriolytic activity. The CSF from a patient with lymfosarcoma, with as much as 2300 cells/mm3, thus was negative. Also the CSF from patients with serous (viral) meningitis was usually negative. Measurement of bacteriolytic activity in CSF may be of diagnostic importance in cases presenting slight elevation of cell number and protein. Further studies of the significance of the bacteriolytic response in meningitis caused by different microorganisms are warranted.

Topics: Adolescent; Aged; Bacteriolysis; Cerebrospinal Fluid; Child; Child, Preschool; Humans; Infant; Meningitis; Meningitis, Viral; Micrococcus; Middle Aged; Muramidase

Cerebrospinal fluid (CSF) and serum lysozyme concentrations were determined in infants and children with and without acute infectious disease of the central nervous system. Serum lysozyme values from patients with bacterial and viral meningitis were found within the normal range. Lysozyme activity was absent or very low (below 0.5 microgram/ml) in normal CSF. High levels (4-12 microgram/ml) in patients with viral meningitis. A decrease of the lysozyme activity coincided with the clinical improvement of the bacterial meningitis. The lysozyme activity in CSF should be of significant value in detecting an inflammatory disease of the central nervous system.

Topics: Bacterial Infections; Child; Child, Preschool; Humans; Infant; Meningitis; Meningitis, Viral; Muramidase

The presence of lysozyme in the CSF is considered with regard to its value in the early diagnosis of primary or secondary CNS Tumours. Since the appearance of this enzyme in the CSF is secondary to the increase of protein in the fluid, the search for lysozyme in the CSF is of no practical help in the diagnosis of CNS tumours.

Topics: Adolescent; Adult; Aged; Brain Neoplasms; Central Nervous System Diseases; Cerebral Ventricles; Child; Child, Preschool; Craniopharyngioma; Cysts; Female; Glioma; Humans; Hydrocephalus; Infant; Male; Meningioma; Meningitis; Middle Aged; Muramidase; Neoplasm Metastasis; Neurilemmoma; Neuroblastoma; Peripheral Nervous System Neoplasms; Time Factors; Vestibulocochlear Nerve

Lysozyme activity was measured in cerebrospinal fluid (CSF) from 114 patients with inflammatory (bacterial and serous meningitis, polyradiculitis, encephalitis) and non-inflammatory (multiple sclerosis, CNS tumors, cerebral vascular diseases) CNS diseases. Highly elevated values were found consistently in patients with bacterial meningitis. Elevated values were found also in patients with encephalitis, polyradiculitis, multiple sclerosis and CNS tumors, but a considerable overlapping between these groups and normal controls precludes the use of CSF lysozyme measurements as a diagnostic aid in the latter disease groups. Simultaneous measurements of lysozyme, albumin and IgG in CSF and serum suggested that the mechanism for increased CSF lysozyme values in bacterial meningitis is mainly a breakdown of the blood/brain barrier, whereas the increased CSF lysozyme values in the remaining groups of patients are more likely caused by production of lysozyme by cells within the meninges (neutrophilic granulocytes, monocytes?).

Topics: Blood-Brain Barrier; Brain Neoplasms; Central Nervous System Diseases; Cerebrovascular Disorders; Encephalitis; Humans; Immunoglobulin G; Male; Meningitis; Multiple Sclerosis; Muramidase; Polyradiculopathy; Serum Albumin

Topics: Communicable Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Muramidase; Otitis; Respiratory Tract Infections

The changes in intraneutrophilic and plasma concentrations of the three antibacterial proteins lysozyme, lactoferrin, and myeloperoxidase were studied sequentially during acute bacterial infection in nine patients. Intraneutrophilic concentrations of the three proteins were decreased by more than 50% during the 1st week of infection, followed by a slow increase over the following 2 weeks. Nadir values coincided with maximal toxic granulation of the neutrophils. The data suggest that neutrophilic granulocytes are deficient during early bacterial infection, possibly because of deficient synthesis of antibacterial proteins in the bone marrow, and that neutrophil toxic granulation is the visual counterpart of this defect. The plasma concentrations of the three proteins showed considerable differences: whereas plasma lysozyme did not show any sequential changes, plasma myeloperoxidase was high at the start of infection and quickly decreased towards normal values, and plasma lactoferrin, high in the first samples, showed a secondary peak 1 week after onset of disease, before normalization was seen. These differences may result from differences in the signals are specific for the individual antibacterial protein and not for the different types of neutrophil granules.

Topics: Adult; Aged; Bacterial Infections; Blood Bactericidal Activity; Humans; Lactoferrin; Lactoglobulins; Meningitis; Middle Aged; Muramidase; Neutrophils; Peroxidase; Peroxidases; Pneumococcal Infections; Time Factors

Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Meningitis; Muramidase; Prognosis

The concentration of lysozyme (LZM) in cerebrospinal fluid (CSF) has been studied in 148 patients to evaluate its possible significance in the differential diagnosis of various diseases affecting the central nervous system (CNS). In the control group only 3 of 45 patients had detectable LZM in their CSF, the highest value being 1.3 mug/ml. The diabetic and epileptic groups did not differ from the control group. Of 8 patients with primary intracranial tumours, 4 had raised CSF-LZM levels. Twenty of 23 uraemic patients had elevated CSF-LZM, the highest value being 3.3 mug/ml. The highest values were found in patients with bacterial meningitis, tuberculous meningitis and leptomeningitis due to Aspergillus. A positive correlation was found between CSF-LZM and protein concentrations. The measurement of LZM may be of value in the diagnosis of inflammatory processes affecting the CNS and in the diagnosis of certain intracranial tumours.

Topics: Aged; Brain Neoplasms; Central Nervous System Diseases; Cerebrovascular Disorders; Diabetic Neuropathies; Epilepsy; Female; Humans; Male; Meningitis; Muramidase

Topics: Brain Neoplasms; Cerebrospinal Fluid; Female; Glioma; Histiocytosis, Langerhans-Cell; Humans; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Male; Meningitis; Muramidase; Neoplasm Metastasis

Topics: Adult; Bone Marrow; Butanols; Creatinine; Freezing; Humans; Leukocyte Count; Meningitis; Methods; Muramidase; Myeloproliferative Disorders; Neutrophils; Osteomyelitis; Pneumonia; Staphylococcal Infections; Ultrasonics; Uremia

Topics: Clinical Enzyme Tests; Diagnosis, Differential; Humans; Meningitis; Meningitis, Meningococcal; Meningitis, Viral; Methods; Muramidase