Cerebrospinal Fluid Adenosine Deaminase Levels and Adverse Neurological Outcome in Pediatric Tuberculous Meningitis

Jakka, S; Veena, Sargoor R.; Rao, Aksay; Eisenhut, Michael

doi:10.1007/s15010-005-5005-4

Cited by 18 publications

(8 citation statements)

References 10 publications

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“…However, this study used only 12 cases of TBM patients, and pyogenic and viral meningitis were not distinguished from the group with other central nervous system diseases. Similarly increased CSF ADA levels have been reported in childhood TBM with adverse neurological outcome [ 27 ]. However, Gambhir et al reported a low sensitivity of 44% and specificity of 75% for ADA test with a cut off value 8 IU/L/min, which showed overlap between TBM and non-TBM patients, especially for infectious neurological disorders like pyogenic meningitis [ 28 ].…”

Section: Discussionsupporting

confidence: 62%

Cerebrospinal fluid adenosine deaminase activity: A complimentary tool in the early diagnosis of tuberculous meningitis

Kashyap

Kainthla

Mudaliar

et al. 2006

Fluids Barriers CNS

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Background: Tuberculous meningitis (TBM) is the commonest form of neurotuberculosis caused by Mycobacterium tuberculosis bacilli (MTB). The diagnosis of TBM is often difficult. A reliable, costeffective and rapid diagnostic test, which can be performed in any standard pathology laboratory, could be of help in the diagnosis of TBM. In the present study we measured the adenosine deaminase (ADA) activity in cerebrospinal fluid (CSF) of TBM and non-TBM patients.

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Section: Discussionsupporting

confidence: 62%

Cerebrospinal fluid adenosine deaminase activity: A complimentary tool in the early diagnosis of tuberculous meningitis

Kashyap

Kainthla

Mudaliar

et al. 2006

Fluids Barriers CNS

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“…Additionally, standardized cutoffs of ADA values for the diagnosis of TBM have not been established, and the values used in the various studies ranged from Ͼ5.0 to Ͼ15 IU/liter, making the practical use of this assay more difficult. CSF ADA measurements have been found to be useful in predicting poor neurological outcomes among pediatric TBM cases (76). It has also been established that isotype ADA2 is the major contributor to the total ADA seen in TBM (the same is true for bacterial meningitis) (187).…”

Section: Molecular and Biochemical Analysismentioning

confidence: 99%

Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects

et al. 2008

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SUMMARY Tuberculosis of the central nervous system (CNS) is a highly devastating form of tuberculosis, which, even in the setting of appropriate antitubercular therapy, leads to unacceptable levels of morbidity and mortality. Despite the development of promising molecular diagnostic techniques, diagnosis of CNS tuberculosis relies largely on microbiological methods that are insensitive, and as such, CNS tuberculosis remains a formidable diagnostic challenge. Insights into the basic neuropathogenesis of Mycobacterium tuberculosis and the development of an appropriate animal model are desperately needed. The optimal regimen and length of treatment are largely unknown, and with the rising incidence of multidrug-resistant strains of M. tuberculosis, the development of well-tolerated and effective antibiotics remains a continued need. While the most widely used vaccine in the world largely targets this manifestation of tuberculosis, the BCG vaccine has not fulfilled the promise of eliminating CNS tuberculosis. We put forth this review to highlight the current understanding of the neuropathogenesis of M. tuberculosis, to discuss certain epidemiological, clinical, diagnostic, and therapeutic aspects of CNS tuberculosis, and also to underscore the many unmet needs in this important field.

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“…In a prospective study from South India, [14] children having TBM with neurological deficit had significantly higher CSF adenosine deaminase (ADA) levels compared with controls. The significantly elevated protein content in the CSF could indicate a more intense tissue reaction mediated by immunity.…”

Section: Discussionmentioning

confidence: 99%

Tuberculous optochiasmatic arachnoiditis

et al. 2010

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Arachnoiditis involving optic nerve and the optic chiasm can occur as a complication of tuberculous meningitis (TBM). This study evaluates the clinical features, cerebrospinal fluid (CSF) and laboratory parameters and imaging findings of optochiasmatic arachnoiditis (OCA) and also tried to identify any factors which can predict this complication in patients with TBM. Patients admitted with TBM in the neurology wards of a tertiary care teaching hospital over a period of 6 years formed the material for this study. Student's "t" test and univariate analysis were done to identify any predictors for this complication and the variables found to be significant were further analyzed by multivariate logistic regression analysis. One hundred sixty-three patients with TBM, admitted over a 6-year period, were studied. Twenty-three (14%) patients developed OCA. Eighteen out of 23 (78%) developed this complication while on antituberculous treatment (ATT) and 5/23 (22%) were newly diagnosed cases of TBM. Of those already on treatment, 12/23 (52%) were receiving only ATT, the remaining 6/23 (26%) had received steroids along with ATT in varying doses and duration. The average period from diagnosis of TBM to visual symptoms was 6.4 months. On the multivariate logistic regression analysis, female sex (P < 0.037), age less than 27 (P < 0.008) years and protein content in the CSF > 260 mg% (P < 0.021) were the factors predisposing toward this complication. At 6 months follow-up, on treatment with steroids and ATT, 17% had improvement and no further deterioration was noted in visual acuity in 52%. OCA can develop even while on treatment with ATT. Young women with a high CSF protein content seem to be more prone for this complication.

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Cerebrospinal Fluid Adenosine Deaminase Levels and Adverse Neurological Outcome in Pediatric Tuberculous Meningitis

Abstract: Adverse neurological outcome in childhood tuberculous meningitis is associated with increased cerebrospinal fluid adenosine deaminase levels.

Cited by 18 publications

References 10 publications

Cerebrospinal fluid adenosine deaminase activity: A complimentary tool in the early diagnosis of tuberculous meningitis

Cerebrospinal fluid adenosine deaminase activity: A complimentary tool in the early diagnosis of tuberculous meningitis

Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects

Tuberculous optochiasmatic arachnoiditis

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