Significance of heat shock protein 70 in cerebrospinal fluid in differential diagnosis of central nervous system infection in children

Objective: To investigate the diagnostic value of heat shock protein 70 (HSP70) in central nervous system infection (CNSI) in children. Methods: The level of HSP70 in the cerebrospinal fluid (CSF) was determined in children with CNSI of different etiology. The concentration of HSP70 was determined in the CSF of 104 children, among them 13 patients had purulent meningitis (PM), 38 patients had acute viral meningitis (VM), 7 patients had tubercalous meningitis (TM), and 46 with no CNSI to serve as controls. The concentration of HSP70 was determined by Western blotting assay. The CSF specimens were also analyzed for the total cellular score (TCS), white blood cell count (WBC), lactate dehydrogenase (LDH), protein content (PC), adenosine deaminase (ADD), glucose, chloride content (Cl^-), and pressure. Results: The CSF level of HSP70 was significantly higher in the PM, TM and VM groups (76.61±27.69, 65.85± 33.16, 33.65±16.93) compared with the control group (23.28±19.77, P<0.05 or P<0.01). The HSP70 concentration was markedly higher in the CSF of patients with PM and TM than patients with VM (both P<0.01). No significant difference was found between PM group and TM group in HSP70 level in CSF (P>0.05). The Concentration of HSP70 in the CSF was positively correlated to TCS (r=0.298, P=0.002), WBC (r=0.274, P=0.005), LDH (r=0.322, P=0.001), PC (r=0.629, P<0.001), ADD (r=0.363, P<0.001), and negatively correlated to the glucose (r=-0.443, P<0.001) in CSF. The HSP70 concentration was not correlated to the CI (r=0.148, P=0.133) and pressure (r=0.001, P=0.993) of CSF. Conclusion: HSP70 is increased in the CSF of patients with CNSI. It may be one of the pathophysiological mechanisms of acute infection of the central nervous system. The level of HSP70 in CSF may be a valuable index in the differential diagnosis of CNSI and it may be helpful in differentiating PM and TM from VM.