Cytokine Levels in Serum and Cerebrospinal Fluid during Tetanus: Possible Immune Activation

Because of the possible involvement of cytokines in tetanus, we investigated the cerebrospinal fluid (CSF) and serum levels of granulocyte-macrophage-CSF (GM-CSF), tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-1 alpha (IL-1 alpha), and interferon-gamma (IFN-gamma) in eight patients affected by uncomplicated tetanus before intrathecal therapy with immunoglobulins. We observed a significant increase of cytokines levels in CSF respect to controls (p<0.001). In particular IFN-gamma, followed by GM-CSF, IL-6 and TNF-alpha, while IL-1 alpha was not detectable in either serum or CSF. Moreover, no correlation was found between serum and CSF cytokine levels. These results could indicate an intrathecal production of these cytokines and a possible immunologic activation occuring in the central nervous system (CNS). Since this study is preliminary, we do not conclude that the measurement of cerebrospinal fluid cytokine levels could represent a useful marker in the course of tetanus.