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Neopterin is produced by monocyte-derived macrophages and dendritic cells in response to interferon-gamma. Its presence in increased concentration in the cerebrospinal fluid (CSF) is indicative of central nervous system (CNS) inflammation. A report from Sydney, Australia (Developmental Medicine and Child Neurology 2009;51:317–23) has described the results of CSF neopterin assays (using high-performance liquid chromatography) in 158 children in a paediatric neurology department. Thirty children aged 2 weeks–13 years had acute neurological disorders. Among these, 10 had various forms of acute encephalitis and all 10 had a raised CSF neopterin concentration (>27.4 nmol/l). Ten of 12 patients with other acute inflammatory CNS disorders (including demyelination, vasculitis, and post-infectious ataxia) also had raised concentrations. Many of this group of patients with acute disorders had concentrations >100 nmol/l. Among 17 children with chronic progressive disorders CSF neopterin concentrations were raised in four of six with an inflammatory disorder and in three of 11 with a metabolic or genetic disorder. Raised levels were also found in four of six children with acute exacerbation of a chronic condition during fever. Among 105 children with chronic static disorders levels were raised in only four. (CSF neopterin levels are high in acute bacterial meningitis but such children were not included …

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