{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:26:09Z","timestamp":1780446369976,"version":"3.54.1"},"reference-count":33,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T00:00:00Z","timestamp":1620259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001656","name":"Helmholtz-Gemeinschaft","doi-asserted-by":"publisher","award":["iMed"],"award-info":[{"award-number":["iMed"]}],"id":[{"id":"10.13039\/501100001656","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001656","name":"Helmholtz-Gemeinschaft","doi-asserted-by":"publisher","award":["Metabolic Dysfunction and Chronic Diseases"],"award-info":[{"award-number":["Metabolic Dysfunction and Chronic Diseases"]}],"id":[{"id":"10.13039\/501100001656","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005624","name":"Medizinischen Hochschule Hannover","doi-asserted-by":"publisher","award":["Junge Akademie"],"award-info":[{"award-number":["Junge Akademie"]}],"id":[{"id":"10.13039\/501100005624","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["Cluster of Excellence RESIST (EXC 2155)-Project ID 390874280"],"award-info":[{"award-number":["Cluster of Excellence RESIST (EXC 2155)-Project ID 390874280"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cells"],"abstract":"<jats:p>The identification of CSF biomarkers for bacterial meningitis can potentially improve diagnosis and understanding of pathogenesis, and the differentiation from viral CNS infections is of particular clinical importance. Considering that substantial changes in CSF metabolites in CNS infections have recently been demonstrated, we compared concentrations of 188 metabolites in CSF samples from patients with bacterial meningitis (n = 32), viral meningitis\/encephalitis (n = 34), and noninflamed controls (n = 66). Metabolite reprogramming in bacterial meningitis was greatest among phosphatidylcholines, and concentrations of all 54 phosphatidylcholines were significantly (p = 1.2 \u00d7 10\u221225\u20131.5 \u00d7 10\u22124) higher than in controls. Indeed, all biomarkers for bacterial meningitis vs. viral meningitis\/encephalitis with an AUC \u2265 0.86 (ROC curve analysis) were phosphatidylcholines. Four of the five most accurate (AUC \u2265 0.9) phosphatidylcholine biomarkers had higher sensitivity and negative predictive values than CSF lactate or cell count. Concentrations of the 10 most accurate phosphatidylcholine biomarkers were lower in meningitis due to opportunistic pathogens than in meningitis due to typical meningitis pathogens, and they correlated most strongly with parameters reflecting blood\u2013CSF barrier dysfunction and CSF lactate (r = 0.73\u20130.82), less so with CSF cell count, and not with blood CRP. In contrast to the elevated phosphatidylcholine concentrations in CSF, serum concentrations remained relatively unchanged. Taken together, these results suggest that increased free CSF phosphatidylcholines are sensitive biomarkers for bacterial meningitis and do not merely reflect inflammation but are associated with local disease and a shift in CNS metabolism.<\/jats:p>","DOI":"10.3390\/cells10051115","type":"journal-article","created":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T11:10:27Z","timestamp":1620299427000},"page":"1115","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Elevated Free Phosphatidylcholine Levels in Cerebrospinal Fluid Distinguish Bacterial from Viral CNS Infections"],"prefix":"10.3390","volume":"10","author":[{"given":"Amani","family":"Al-Mekhlafi","sequence":"first","affiliation":[{"name":"Biostatistics, Helmholtz Centre for Infection Research, 38124 Braunschweig, Germany"},{"name":"PhD Programme Epidemiology, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8077-481X","authenticated-orcid":false,"given":"Kurt-Wolfram","family":"S\u00fchs","sequence":"additional","affiliation":[{"name":"Department of Neurology, Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Schuchardt","sequence":"additional","affiliation":[{"name":"Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maike","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Research Group Biomarkers for Infectious Diseases, TWINCORE Centre for Experimental and Clinical Infection Research, 30625 Hannover and Helmholtz Centre for Infection Research, 38124 Braunschweig, Germany"},{"name":"Research Core Unit Metabolomics, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"M\u00fcller-Vahl","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinna","family":"Trebst","sequence":"additional","affiliation":[{"name":"Department of Neurology, Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8550-335X","authenticated-orcid":false,"given":"Thomas","family":"Skripuletz","sequence":"additional","affiliation":[{"name":"Department of Neurology, Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9613-182X","authenticated-orcid":false,"given":"Frank","family":"Klawonn","sequence":"additional","affiliation":[{"name":"Biostatistics, Helmholtz Centre for Infection Research, 38124 Braunschweig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2504-5398","authenticated-orcid":false,"given":"Martin","family":"Stangel","sequence":"additional","affiliation":[{"name":"Department of Neurology, Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, 30625 Hannover, Germany"},{"name":"Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, 30625 Hannover, Germany"},{"name":"Centre for Individualised Infection Medicine, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3434-2311","authenticated-orcid":false,"given":"Frank","family":"Pessler","sequence":"additional","affiliation":[{"name":"Research Group Biomarkers for Infectious Diseases, TWINCORE Centre for Experimental and Clinical Infection Research, 30625 Hannover and Helmholtz Centre for Infection Research, 38124 Braunschweig, Germany"},{"name":"Centre for Individualised Infection Medicine, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,6]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2020, December 15). 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