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Nitric Oxide Synthesis in Meningococcal Meningitis
- Jelle J. Visser, PhD;
- Rob J. P. M. Scholten, MD; and
- Klaas Hoekman, MD
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TO THE EDITOR:
Clinical meningitis arises largely from the inflammatory response to bacteria invading the cerebrospinal fluid. Because nitric oxide, an endogenous mediator with vasodilator, neurotransmitter, and cytotoxic activities may be involved [1], we measured cerebrospinal fluid levels of nitrate and nitrite, the stable degradation products of nitric oxide, in 94 patients with meningococcal meningitis and in 44 patients with noninflammatory neurologic disease.
Controls had mean cerebrospinal fluid nitrate levels of 6.3 µmol/L (range, 2.3 to 17.3 µmol/L) and nitrite levels of 0.5 µmol/L (range, 0.4 to 1.7 µmol/L). Compared with controls, patients with meningitis had a mean nitrate level of 18.4 µmol/L (range, 3.1 to 150.7 µmol/L) and a mean nitrite level of 25.8 µmol/L (range, 0.2 to 330.2 µmol/L) (P < 0.001, Mann-Whitney test). Because Neisseria meningitidis is not known to form nitrate or nitrite, these increases must have resulted from increased endogenous production through the only known metabolic route for their formation in body tissues, namely degradation of nitric oxide [2]. Our findings show that nitric oxide synthesis is induced in cells within the central nervous system compartment in response to bacterial invasion.
The pathophysiologic significance of the local increase in nitric oxide remains to be elucidated. High levels of nitric oxide are known to be toxic to endothelial cells and neurons [3, 4]; consequently, local increases in nitric oxide may play a role in the microvascular damage and the neurologic sequelae of meningitis. If so, treatment with specific inhibitors of inducible nitric oxide synthesis might be beneficial in patients with bacterial meningitis.
Jelle J. Visser, PhD
Rob J. P. M. Scholten, MD
Klaas Hoekman, MD
Free University Hospital; 1007 MB Amsterdam; The Netherlands
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
