Procoagulant and fibrinolytic activity in cerebrospinal fluid from adults with bacterial meningitis

Objectives: This study investigated levels of coagulation and fibrinolysis factors in cerebrospinal fluid (CSF) from adults with bacterial meningitis in relation to development of brain infarction. Methods: CSF was collected from 92 adults with community-acquired bacterial meningitis, who participated in the prospective Dutch Meningitis Cohort Study; 8 patients with viral meningitis and 9 healthy control subjects. Levels of proteins involved in the coagulation cascade were determined by eans of immunoassays. Results: Bacterial meningitis was accompanied by local. activation of coagulation, as shown by significantly higher CSF soluble tissue factor (P < 0.001) and prothrombin fragment F1+2 concentrations (P < 0.001) as compared to viral meningitis patients and controls. This was accompanied by a significantly higher D-dimer formation (P < 0.001). In addition, in bacterial meningitis fibrinolysis was attenuated, since CSF plasminogen activator inhibitor (PAI)-1 levels were significantly higher as compared to the controls (P = 0.02). In patients with bacterial meningitis who developed brain infarction, CSF PAI-1 levels were higher than in those without infarction (P = 0.04). Conclusions: Activation of coagulation and attenuation of fibrinolysis in the CSF are important features of bacterial meningitis; the net effect on fibrin turnover may contribute to the development of brain infarction. (C) 2006 The British Infection Society. Published by Elsevier Ltd. All rights reserved.