Meningism immunoglobulin

Concentration of transferrin in CSF does not correlate with serum levels. This suggests consideration of the presence of a speciflc transport system for transferrin in the blood-CSF barrier. This transport system may be similar to that, for instance, for immunoglobulins (transcytosis). Only as an epiphenomenon is there a signiflcant decrease of serum concentrations of transferrin, as in cases of ulcerous meningitis and malignant meningeal inflltration. In this case other methods are required to determine the levels with any degree of precision (A24, Zl). 

During inflammation, permeability increases in the blood-CSF barrier, elevating levels of sICAM in the CSF. Thus, in settings of acute meningitis, multiple sclerosis, and Guillain-Barre polyradiculoneuritis, CSF concentrations of 44 /rg L 4.5 ixg L and 16.2 /rg L respectively, were measured (R8). A precise, quantitative differentiation between the serum portion and the intrathecal fraction, comparable to the immunoglobulins, is still not possible therefore, the ICAM index represents the best approximation ... 

KIO. Kostic, A., VujoSevic, M., Svirtlih, N., and Kanjuh, B., Cerebrospinal fluid immunoglobulins in acute aseptic meningitis and meningoencephaUtis. Period. Biol. 81, 477-480 (1979). 

The authors thought it unlikely that aseptic meningitis had been caused by an allergic reaction. They proposed that the mechanism of aseptic meningitis involved the entry of immunoglobulin molecules into the cerebrospinal fluid, causing an inflammatory reaction. 

Two children with idiopathic thrombocytopenic purpura developed aseptic meningitis after receiving intravenous immunoglobulin 1 g/kg/day, with unusual large numbers of leukocytes in the cerebrospinal fluid (62). 

To prevent aseptic meningitis, it has been advised that intravenous immunoglobulin should be infused at a slow rate and that diluted immunoglobulin solutions should be used (58). Aseptic meningitis can be prevented by the administration of propranolol (41,58). In addition, prehydration and an antihistamine have been helpful in some patients (41,58). 

Jolles S, Hill H. Management of aseptic meningitis secondary to intravenous immunoglobulin. BMJ 1998 316(7135) 936. 

Attout H, Mallet H, Desmurs H, Berthier S, Gil H, de Wazieres B, Dupond JL. Meningite aseptique an course d un traitement par immunoglobulines intraveineuses a tres faibles doses. [Aseptic meningitis during treatment with very low doses of intravenous immunoglobulins.] Rev Med Interne 1998 19(2) 140-1. 

Al-Ghamdi H, Mustafa MM, Al-Fawaz I, Al-Dowaish A. Acute aseptic meningitis associated with administration of immunoglobulin in children a case of report and review of the literature. Ann Saudi Med 1999 19 362. ... 

Obando I, Duran I, Martin-Rosa L, Cano JM, Garcia-Martin FJ. Aseptic meningitis due to administration of intravenous immunoglobulin with an unusually high number of leukocytes in cerebrospinal fluid. Pediatr Emerg Care 2002 18(6) 429-32. 

Cell-mediated immunity appears to play a major role in host defense against infection with C. neoformans 29% to 55% of patients with cryptococcal meningitis have a predisposing condition. Many patients with disseminated cryptococcosis demonstrate defects in cell-mediated immunity. The predilection of C. neoformans for the CNS appears to be caused by the lack of immunoglobulins and complement and the excellent growth medium afforded by CSF. ... 

Other adverse reactions include lightheadedness [40 ], fainting [39 ], and self-limiting aseptic meningitis, which occurs occasionally 48-72 hours after the first dose [30 ]. One patient with chronic spontaneous urticaria developed symptoms of aseptic meningitis on day 3 of a 5-day cycle of intravenous immunoglobulin the immunoglobulin was withdrawn and the urticaria returned to baseline in 2 weeks [56 ]. 

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