A Pattern of Cytokine Response in Suspected HIV-Negative Tuberculous Meningitis Patients, a Study from Tertiary Neurocenter in India

Background: Tuberculous Meningitis (TBM) is the most severe and chronic illness. Studying the association between mycobacterial burden and Cerebrospinal Fluid (CSF) parameters is crucial for understanding the cytokine-driven inflammatory response and disease severity. The primary objective of this study is to quantify cytokine levels in CSF and establish correlations with CSF parameters among patients with TBM, grouped by disease severity. Materials and methods: A study included 50 TBM cases (25- Definite and 25-Probable) and 20 controls. The IL2, IL6, IFNγ, TNFα, and IL10 levels were estimated by Cytometric Bead Array (CBA) and compared between patients and controls. Results: TBM patients exhibited significantly elevated levels of IL2, IL6, IFNγ, TNFα, and IL10 compared to controls. A significant correlation was identified among, (a) TBM with tuberculoma cases i) A correlation between CSF lymphocyte count and IL10 levels and ii) A correlation between PMN leukocyte count and IL10 levels; and (c) TBM with hydrocephalus cases displayed a correlation between PMN leukocyte count and IL10 levels. Notably, in TBM group, only confirmed TBM cases demonstrated an altered cytokine pattern with varying levels of cellularity. Conclusion: These findings offer valuable insights into the immunological mechanisms involved in TBM, highlighting the importance of mycobacterial load and immune cell count in intensifying cytokine response. Moreover, they shed light on the intricate interplay of these factors in influencing disease severity and prognosis. The implications of these observations are significant and underscore the need for further research in this area.