ABSTRACT
OBJECTIVE: To evaluate the use of cerebrospinal fluid (CSF) ferritin levels in the diagnosis of purulent meningitis (PM). METHOD: We studied 81 children between 28 days and 12 years of age who presented with clinical suspicion of meningitis to the emergency department. CSF ferritin levels were measured and compared between diagnostic groups (PM, aseptic meningitis (AM) and no meningitis). RESULTS: The median age was 24 (IQR 8-69) months. There were 32 patients with AM (39%), 23 with PM (28%) and 26 with no meningitis (32%). Median CSF ferritin was 4.2 ng/mL (IQR 3.0-6.5), 52.9 ng/mL (IQR 30.7-103 ng/mL) and 2.4 ng/mL (IQR 2-4), respectively. CSF ferritin was higher in children with PM compared with AM (p<0.001) or no meningitis (p<0.001). There was no difference between AM and no meningitis. CONCLUSION: CSF ferritin may be a useful biomarker to discriminate PM in children with clinical symptoms of this disease.
Subject(s)
Cerebrospinal Fluid/metabolism , Ferritins/cerebrospinal fluid , Meningitis, Aseptic/cerebrospinal fluid , Meningitis, Bacterial/cerebrospinal fluid , Biomarkers/analysis , Brazil/epidemiology , Case-Control Studies , Cerebrospinal Fluid/microbiology , Child , Child, Preschool , Cross-Sectional Studies , Emergency Service, Hospital , Female , Hospitalization , Humans , Infant , Infant, Newborn , Male , Meningitis, Aseptic/diagnosis , Meningitis, Aseptic/microbiology , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/microbiologyABSTRACT
Several markers have been studied for their ability to make the CNS infiltration diagnosis earlier and more precise; previous studies showed that CSF ferritin concentrations were higher in patients with malignant invasion of CNS. The objective was to determine the importance of CSF ferritin as a biomarker for the diagnosis of CNS neoplastic infiltration. This study is based on 93 CSF samples, divided into five groups: malignant cells present (n13); malignant cells not present (n26); inflammatory neurological diseases (n16); neurocysticercosis (n20); acute bacterial meningitis (n18). CSF ferritin values were determined by micro particle enzyme immunoassay. CSF ferritin level (mean+/-SD) in the group with neoplastic cells in the CSF was 42.8+/-49.7 ng/mL, higher than in the other groups (p<0.0001). We conclude that CSF ferritin with the cut off 20 ng/mL could be an adjuvant biomarker to the diagnosis of CNS malignant infiltration.
Subject(s)
Biomarkers, Tumor/cerebrospinal fluid , Central Nervous System Neoplasms/cerebrospinal fluid , Ferritins/cerebrospinal fluid , Central Nervous System Neoplasms/diagnosis , Enzyme-Linked Immunosorbent Assay , Humans , Sensitivity and SpecificityABSTRACT
Several markers have been studied for their ability to make the CNS infiltration diagnosis earlier and more precise; previous studies showed that CSF ferritin concentrations were higher in patients with malignant invasion of CNS. The objective was to determine the importance of CSF ferritin as a biomarker for the diagnosis of CNS neoplasic infiltration. This study is based on 93 CSF samples, divided into five groups: malignant cells present (n13); malignant cells not present (n26); inflammatory neurological diseases (n16); neurocysticercosis (n20); acute bacterial meningitis (n18). CSF ferritin values were determined by micro particle enzyme immunoassay. CSF ferritin level (mean±SD) in the group with neoplasic cells in the CSF was 42.8±49.7 ng /mL, higher than in the other groups (p<0.0001). We conclude that CSF ferritin with the cut off 20 ng/mL could be an adjuvant biomarker to the diagnosis of CNS malignant infiltration.
Diversos marcadores foram estudados com a finalidade de avaliar sua capacidade de diagnosticar a infiltração neoplásica no SNC precocemente e de forma mais precisa. Estudos anteriores mostraram que as concentrações de ferritina no LCR eram mais elevadas nos pacientes com infiltração neoplásica no SNC. O objetivo foi determinar a importância da ferritina no LCR como biomarcador para o diagnóstico de infiltração neoplásica no SNC. Este estudo é baseado em 93 amostras do LCR, divididas em cinco grupos: células malignas presentes (n13); células malignas ausentes (n26); doenças neurologicas inflamatórias (n16); neurocisticercose (n20); meningites bacterianas agudas (n18). Os valores de ferritina no LCR foram determinados por ELISA de microparticulas. O nível de ferritina no LCR (média±desvio padrão) no grupo com células neoplásicas no LCR foi 42,8±49,7 ng/mL, mais elevado do que nos outros grupos (p<0.0001). Concluímos que a ferritina no LCR com cut off de 20 ng/mL pode ser um biomarcador para o diagnóstico de infiltração maligna no SNC.
Subject(s)
Humans , Central Nervous System Neoplasms/cerebrospinal fluid , Ferritins/cerebrospinal fluid , Biomarkers, Tumor/cerebrospinal fluid , Central Nervous System Neoplasms/diagnosis , Enzyme-Linked Immunosorbent Assay , Sensitivity and SpecificityABSTRACT
In southern Brazil, there is an endemic high prevalence foci of HTLV-I and HTLV-II infection. HTLV-infected individuals may develop HAM/TSP. Little is known about HAM/TSP pathogenesis and there is a lack of disease progression markers. This study investigated ferritin, S-100beta protein, and guanine nucleotides (GN) concentrations in the CSF of 18 patients with HAM/TSP. In HAM/TSP patients, concentrations of ferritin and S100beta were increased, whereas GMP was reduced. CSF ferritin, S100beta, and GN are potential markers for HAM/TSP.
Subject(s)
Ferritins/cerebrospinal fluid , Guanine Nucleotides/cerebrospinal fluid , Human T-lymphotropic virus 1 , Paraparesis, Tropical Spastic/cerebrospinal fluid , S100 Proteins/cerebrospinal fluid , Adult , Aged , Biomarkers , Disease Progression , Female , Humans , Male , Middle Aged , Paraparesis, Tropical Spastic/diagnosis , Predictive Value of TestsABSTRACT
A freqüência de células blásticas no líquor, ao diagnóstico das leucemias agudas, é de 10 a 15 por cento. A leucemia do sistema nervoso central propcia a recaída medular, tornando-se um fator de mau prognóstico. A sua identificaçao é feita, rotineiramente, através do exame citomorfológico - por vezes, nao satisfatório. A determinaçao da ferritina em amostras de líquor pode servir como marcador para a leucemia do sistema nervoso central. Níveis de ferritina acima de 5ng/ml no líquor mostraram associaçao com a infiltraçao leucêmica e com a possibilidade de progressao da leucemia medular ou nao, mesmo na ausência de blastos na amostra. O Serviço de Hematologia do Hospital de Clínicas de Porto Alegre, no período de março/90 a dezembro/94, estudou 106 pacientes: em 94/106 (88 por cento), o diagnóstico foi leucemia linfoblástica; e em 12/106 (12 por cento), leucemia mieloblástica. O exame citomorfológico do líquor, no momento do diagnóstico, foi positivo para blastos em 17/106 (16 por cento), dos quais 15/17 eram portadores de leucemia linfoblástica e 2/17 de leucemia mieloblástica. A dosegem da ferritina liquórica foi acima de 5 ng/ml em 31/106 (29 por cento) dos pacientes, onde 11/31 apresentaram presença de blastos no exame citológico, enquanto 20/31 tinham líquor negativo. Em 7/20 pacientes com líquor negativo para blastos, mas com a ferritina liquórica elevada, houve recaída precoce da leucemia. A ferritina liquórica parece ser um indicador da leucemia, tanto do sistema nervoso central, quanto da hematológica: níveis elevados, além de 5 ng/ml, sao um sinal de alerta para a evoluçao da leucemia, com recidiva entre os primeiros 12 e 18 meses de diagnóstico. A alteraçao na dosagem de ferritina do líquor sugere que o especialista realize punçoes lombares freqüentes, com o intuito de detectar o mais precocemente possível o acometimento leucêmico do sistema nervoso central ou de considerar a possibilidade de intensificaçao das profilaxias com esquemas quimioterápicos e/ou radioterápicos adequados.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Central Nervous System/pathology , Ferritins/cerebrospinal fluid , Leukemia, Lymphoid/pathology , Leukemia, Myeloid, Acute/pathology , Leukemic Infiltration , Acute Disease , Biomarkers, Tumor , Neoplasm Recurrence, LocalABSTRACT
In order to evaluate whether cerebrospinal fluid (CSF) ferritin could be useful to determine early infiltration of central nervous system (CNS) in patients with malignant lymphoma, the ferritin concentration was measured in 30 previously untreated patients with malignant lymphoma without evidence of neurologic infiltration. Six patients showed elevation of CNS ferritin 2 to 6 months after clinical and cytologic diagnosis of CNS involvement was confirmed. Twenty-four patients with normal CSF ferritin did not show involvement of CNS 6 to 23 months after the study was done. Measurement of CNS ferritin appears to be important in the early detection of CNS involvement of malignant lymphoma and should be included in the clinical evaluation to detect patients at high-risk to develop this complication and prophylaxis could be done to avoid it.