Procoagulant and fibrinolytic activity in cerebrospinal fluid from adults with bacterial meningitis

J Infect. 2007 Jun;54(6):545-50. doi: 10.1016/j.jinf.2006.11.016. Epub 2007 Jan 4.


Objectives: This study investigated levels of coagulation and fibrinolysis factors in cerebrospinal fluid (CSF) from adults with bacterial meningitis in relation to development of brain infarction.

Methods: CSF was collected from 92 adults with community-acquired bacterial meningitis, who participated in the prospective Dutch Meningitis Cohort Study; 8 patients with viral meningitis and 9 healthy control subjects. Levels of proteins involved in the coagulation cascade were determined by means of immunoassays.

Results: Bacterial meningitis was accompanied by local activation of coagulation, as shown by significantly higher CSF soluble tissue factor (P<0.001) and prothrombin fragment F1+2 concentrations (P<0.001) as compared to viral meningitis patients and controls. This was accompanied by a significantly higher D-dimer formation (P<0.001). In addition, in bacterial meningitis fibrinolysis was attenuated, since CSF plasminogen activator inhibitor (PAI)-1 levels were significantly higher as compared to the controls (P=0.02). In patients with bacterial meningitis who developed brain infarction, CSF PAI-1 levels were higher than in those without infarction (P=0.04).

Conclusions: Activation of coagulation and attenuation of fibrinolysis in the CSF are important features of bacterial meningitis; the net effect on fibrin turnover may contribute to the development of brain infarction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Case-Control Studies
  • Cerebral Infarction / cerebrospinal fluid
  • Child
  • Coagulants / cerebrospinal fluid*
  • Cohort Studies
  • Female
  • Fibrinolysis*
  • Humans
  • Male
  • Meningitis, Bacterial / cerebrospinal fluid*
  • Meningitis, Bacterial / drug therapy
  • Meningitis, Bacterial / physiopathology
  • Middle Aged


  • Anti-Bacterial Agents
  • Coagulants