{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T02:44:28Z","timestamp":1778813068920,"version":"3.51.4"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T00:00:00Z","timestamp":1615507200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Research Foundation SARChI Chair of Clinical Neurosciences"},{"DOI":"10.13039\/501100004513","name":"Harry Crossley Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004513","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001322","name":"South African Medical Research Council","doi-asserted-by":"publisher","award":["National Medical Students Research Training Programme"],"award-info":[{"award-number":["National Medical Students Research Training Programme"]}],"id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Tuberculous meningitis (TBM) is the most fatal form of tuberculosis and frequently occurs in children. The inflammatory process initiates secondary brain injury processes that lead to death and disability. Much remains unknown about this cerebral inflammatory process, largely because of the difficulty in studying the brain. To date, studies have typically examined samples from sites distal to the site of disease, such as spinal cerebrospinal fluid (CSF) and blood. In this pilot study, we examined the feasibility of using direct brain microdialysis (MD) to detect inflammatory mediators in brain extracellular fluid (ECF) in TBM. MD was used to help guide neurocritical care in 7 comatose children with TBM by monitoring brain chemistry for up to 4 days. Remnant ECF fluid was stored for offline analysis. Samples of ventricular CSF, lumbar CSF and blood were collected at clinically indicated procedures for comparison. Inflammatory mediators were quantified using multiplex technology. All inflammatory markers, with the exception of interleukin (IL)-10 and IL-12p40, were detected in the ECF. Cytokine concentrations were generally lower in ECF than ventricular CSF in time-linked specimens. Individual cases showed ECF cytokine increases coinciding with marked increases in ECF glycerol or decreases in ECF glucose. Cytokine levels and glycerol were generally higher in patients with more severe disease. This is the first report of inflammatory marker analysis from samples derived directly from the brain and in high temporal resolution, demonstrating feasibility of cerebral MD to explore disease progression and possibly therapy response in TBM.<\/jats:p>","DOI":"10.1371\/journal.pone.0246997","type":"journal-article","created":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T18:34:16Z","timestamp":1615574056000},"page":"e0246997","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["A pilot study of inflammatory mediators in brain extracellular fluid in paediatric TBM"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0554-0586","authenticated-orcid":true,"given":"Nicholas W.","family":"Loxton","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4469-4935","authenticated-orcid":true,"given":"Ursula K.","family":"Rohlwink","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9152-3506","authenticated-orcid":true,"given":"Mvuwo","family":"Tshavhungwe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindizwe","family":"Dlamini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8776-4737","authenticated-orcid":true,"given":"Muki","family":"Shey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nico","family":"Enslin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Figaji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,3,12]]},"reference":[{"issue":"10","key":"pone.0246997.ref001","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1038\/nrneurol.2017.120","article-title":"Tuberculous meningitis","volume":"13","author":"RJ Wilkinson","year":"2017","journal-title":"Nat Rev Neurol"},{"issue":"2","key":"pone.0246997.ref002","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1002\/JLB.MR0318-102R","article-title":"The pathogenesis of tuberculous meningitis","volume":"105","author":"AG Davis","year":"2019","journal-title":"J Leukoc Biol"},{"issue":"8","key":"pone.0246997.ref003","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1093\/cid\/cix540","article-title":"Biomarkers of Cerebral Injury and Inflammation in Pediatric Tuberculous Meningitis","volume":"65","author":"UK Rohlwink","year":"2017","journal-title":"Clin Infect Dis"},{"issue":"8","key":"pone.0246997.ref004","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1086\/378642","article-title":"Pathophysiology and prognosis in vietnamese adults with tuberculous meningitis","volume":"188","author":"GE Thwaites","year":"2003","journal-title":"J Infect Dis"},{"issue":"10","key":"pone.0246997.ref005","doi-asserted-by":"crossref","first-page":"e301","DOI":"10.1097\/INF.0000000000001236","article-title":"Imaging Features of the Brain, Cerebral Vessels and Spine in Pediatric Tuberculous Meningitis With Associated Hydrocephalus","volume":"35","author":"UK Rohlwink","year":"2016","journal-title":"Pediatr Infect Dis J"},{"issue":"2","key":"pone.0246997.ref006","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/S0009-8981(01)00573-3","article-title":"Dynamics of brain-derived proteins in cerebrospinal fluid","volume":"310","author":"H. 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