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Clinical Chemistry 44: 161-167, 1998;
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(Clinical Chemistry. 1998;44:161-167.)
© 1998 American Association for Clinical Chemistry, Inc.

General Clinical Chemistry

Neopterin concentrations in cerebrospinal fluid and serum as an aid in differentiating central nervous system and peripheral infections in children

Michael M. Millner1, Wolfgang Franthal1, Gabriela H. Thalhammer1, Andrea Berghold2, Reingard M. Aigner3, Gerhard F. Füger3, and Gilbert Reibnegger4,a

1 Department of Pediatrics, Neuropsychiatric Group,
2 Institute of Medical Informatics, Statistics and Documentation,
3 Department of Radiology, and
4 Institute of Medical Chemistry and Pregl Laboratory, Karl-Franzens-University of Graz, A-8010 Graz, Austria.
a Address correspondence to this author at: Medizinisch-Chemisches Institut und Pregl-Labor, Harrachgasse 21/II, A-8010 Graz, Austria. Fax *43-316-380-9610; e-mail gilbert.reibnegger{at}kfunigraz.ac.at.

Neopterin is a sensitive indicator for cellular immune activation. Its concentrations were determined in cerebrospinal fluid (CSF) and serum specimens from 91 children with no evidence of central nervous system (CNS) or peripheral inflammations, 43 with definite neuroborreliosis, 51 with other CNS infections, and 33 with peripheral infections. The aim of our study was (a) to establish a range of normal CSF neopterin concentrations in control children, and (b) to inquire into the diagnostic potential of neopterin measurements in both body compartments for aiding in differential diagnosis of inflammatory vs noninflammatory diseases, and CNS vs peripheral inflammations. CSF neopterin concentrations in controls were invariably low (up to 9.3 nmol/L), but in children with neuroborreliosis and, even more so, with other CNS infections neopterin concentrations were significantly (P <0.0001) increased. Children with peripheral infections, however, rarely showed raised CSF neopterin concentrations. Serum concentrations of neopterin, on the other hand, were not significantly different between controls and children with neuroborreliosis. Although serum concentrations were significantly different between controls and children with other CNS infections, diagnostic efficiency was poor for this comparison. Peripheral infections, in contrast, were associated with significantly higher (P <0.0001) serum neopterin concentrations when compared with controls. A classification tree was constructed on the basis of CSF and serum neopterin concentrations, allowing with high accuracy the discrimination between controls, children with CNS infections, and children with peripheral infections. Thus, on the basis of a comparatively large control group, our data underline the diagnostic validity of neopterin as an aid in differential diagnosis of inflammatory vs noninflammatory diseases, and confirm that CSF neopterin concentrations are not correlated with serum neopterin concentrations, and, therefore, CSF neopterin appears to be produced intrathecally.




The following articles in journals at HighWire Press have cited this article:


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T. B. Grammer, D. Fuchs, B. O. Boehm, B. R. Winkelmann, and W. Maerz
Neopterin as a Predictor of Total and Cardiovascular Mortality in Individuals Undergoing Angiography in the Ludwigshafen Risk and Cardiovascular Health Study
Clin. Chem., June 1, 2009; 55(6): 1135 - 1146.
[Abstract] [Full Text] [PDF]

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 Toxicol Ind HealthHome page
O. C. Ulker, B. Yucesoy, M. Durucu, and A. Karakaya
Neopterin as a marker for immune system activation in coal workers' pneumoconiosis
Toxicology and Industrial Health, April 1, 2007; 23(3): 155 - 160.
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M. R. Pranzatelli, K. Hyland, E. D. Tate, L. A. Arnold, T. J. Allison, and G. S. Soori
Evidence of Cellular Immune Activation in Children With Opsoclonus-Myoclonus: Cerebrospinal Fluid Neopterin
J Child Neurol, December 1, 2004; 19(12): 919 - 924.
[Abstract] [PDF]


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