Diagnostic and prognostic value of Mycobacterium tuberculosis complex specific interferon gamma release assay in patients with tuberculous meningitis

Vidhate, Mukund R; Singh, Maneesh; Garg, Ravindra Kumar; Verma, Rajesh; Shukla, Rakesh; Goel, Madhu Mati; Makker, Annu; Jain, Amita

doi:10.1016/j.jinf.2011.03.009

Cited by 20 publications

(17 citation statements)

References 13 publications

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“…Our child obtained an IGRA on whole blood indeterminate, in accordance with Vidhate and colleagues [24] who found that whole blood QFT-G-IT had low sensitivity and specificity in diagnosing TBM and CSF QFT-G-IT was useful neither in diagnosis nor in predicting the outcome, due to indeterminate results.…”

Section: Discussionsupporting

confidence: 88%

Immunological diagnosis as an adjunctive tool for an early diagnosis of tuberculous meningitis of an immune competent child in a low tuberculosis endemic country: a case report

et al. 2017

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BackgroundPediatric tuberculous meningitis is a highly morbid, often fatal disease. Its prompt diagnosis and treatment saves lives, in fact delays in the initiation of therapy have been associated with high mortality rates.Case presentationThis is a case of an Italian child who was diagnosed with tuberculous meningitis after a history of a month of headache, fatigue and weight loss. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis with predominance and decreased glucose concentration. Microscopy and conventional diagnostic tests to identify Mycobacterium tuberculosis were negative, while a non classical method based on intracellular cytokine flow cytometry response of CD4 cells in cerebral spinal fluid helped us to address the diagnosis, that was subsequently confirmed by a nested polymerase chain reaction amplifying a 123 base pair fragment of the M. tuberculosis DNA.ConclusionsWe diagnosed tuberculous meningitis at an early stage through an innovative immunological approach, supported by a nested polymerase chain reaction for detection of M. tuberculosis DNA. An early diagnosis is required in order to promptly initiate a therapy and to increase the patient’s survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-017-2444-9) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 88%

Immunological diagnosis as an adjunctive tool for an early diagnosis of tuberculous meningitis of an immune competent child in a low tuberculosis endemic country: a case report

et al. 2017

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“…Most of the included studies (17/20, 85%) were conducted in high‐income countries (Japan, Republic of Korea, Taiwan, Germany, Italy), with the remainder in low/middle‐income countries (South Africa, India). Most of the studies recruited adult patients with the exception of one study which recruited a few of children with tuberculous meningitis (Vidhate et al ., ). The median (range) sample size was 85.6 ± 52.1.…”

Section: Resultsmentioning

confidence: 97%

“…We conjectured that the different analysis results may result from different groups of participants in different countries and populations, or that HIV infection decreased the ability of T‐SPOT to screen for active TB. The sensitivity of QFT was very low in low/middle‐income countries in the present meta‐analysis; this might be due to depressed immune response to TB antigens in severe or disseminated active TB as there were more severe TB cases in low/middle‐income countries, and a decreased IFN‐γ response might result in more false negative QFT results in the diagnosis of EPTB (Vekemans et al ., ; Vidhate et al ., ). The other possibility might be cut‐off values or spots of IGRAs: all included studies performed IGRAs according to standard manufacturer's instructions, and cut‐off values among the different countries were slightly different, but this did not influence heterogeneity of meta‐analysis as we calculated the threshold effects (data not shown).…”

Section: Discussionmentioning

confidence: 97%

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Interferon-gamma release assays for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis

Fan

Zhou

Hao

et al. 2012

FEMS Immunol Med Microbiol

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Interferon -gamma release assays (IGRAs) provide a new diagnostic method for Mycobacterium tuberculosis (TB) infection. However, the diagnostic value of IGRAs for extrapulmonary TB (EPTB) has not been clarified. We searched several databases and selected papers with strict inclusion criteria, evaluated the evidence of commercially available IGRAs (QuantiFERON(®) -TB Gold QFT-G or QFT-GIT and T-SPOT(®) .TB) on blood and the tuberculin skin test (TST) using random effects models. Twenty studies with 1711 patients were included. After excluding indeterminate results, pooled sensitivity for the diagnosis of EPTB was 72% [95% confidence interval (CI) 65-79%] for QFT-G or GIT and 90% (95% CI, 86-93%) for T-SPOT; in high-income countries the sensitivity of QFT-G or GIT (79%, 95% CI 72-86%) was much higher than that (29%, 95% CI 14-48%) in low/middle-income countries. Pooled specificity for EPTB was 82% (95% CI 78-87%) for QFT-G or GIT and 68% (95% CI 64-73%) for T-SPOT. Pooled sensitivity of TST from four studies in high-income countries was lower than that of IGRAs. T-SPOT was more sensitive in detecting EPTB than QFT-G or GIT and TST. However, both IGRAs and TST have similar specificity for EPTB. IGRAs have limited value as diagnostic tools to screen and rule out EPTB, especially in low/middle-income countries. The immune status of patients does not affect the diagnostic accuracy of IGRAs for EPTB.

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“…When tests for these infectious causes are negative, the diagnosis can be elusive. Available diagnostic tests for tuberculous meningitis, the most common cause of chronic meningitis, are not very sensitive (even the newer interferon gamma release assays, which are generally more sensitive than older methods, have reported sensitivities ranging from 44% to 71%) 2, 3 . Consequently, many clinicians advocate empiric treatment for tuberculous meningitis in patients with hypoglycorrhachia, meningeal symptoms, and negative diagnostic tests 4 .…”

Section: Introductionmentioning

confidence: 99%

The Differential Diagnosis of Hypoglycorrhachia in Adult Patients

Chow

Troy

2014

The American Journal of the Medical Sciences

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Objectives Hypoglycorrhachia, or a low glucose level in the cerebrospinal fluid (CSF), can suggest bacterial, fungal, or tuberculous meningitis. When tests for these common infectious etiologies are negative, many clinicians are unsure of which diagnoses to consider, resulting in delayed treatment. We analyzed the diagnoses associated with hypoglycorrhachia to determine their relative frequencies at our institution, as well as summarizing all the diagnoses associated with hypoglycorrhachia in the literature. Methods Retrospective analysis of adults with hypoglycorrhachia at a tertiary care teaching hospital over a 5 year period. Inclusion criteria included CSF glucose <40 mg/dL and age ≥ 18 years old. Exclusion criteria included CSF/serum glucose ≥ 0.6. Results 89 unique hypoglycorrhachia episodes were identified. The most common etiologies amongst all episodes of hypoglycorrhachia were bacterial meningitis (24%), fungal meningitis (15%), stroke/bleeds (13%), malignancy (11%), viral meningitis (6%), neurosarcoidosis (4%), neurosyphilis (4%), and cerebral toxoplasmosis (3%). The most common etiology was fungal meningitis (38%) among HIV–infected patients, and bacterial meningitis (62%) among neurosurgery patients. However, in patients without HIV or neurosurgical history, noninfectious etiologies (stroke/bleed (24%) and malignancy (22%)) were most common. Conclusions Many diagnoses, both infectious and noninfectious, lead to hypoglycorrhachia and must be considered in the differential diagnosis.

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Diagnostic and prognostic value of Mycobacterium tuberculosis complex specific interferon gamma release assay in patients with tuberculous meningitis

Cited by 20 publications

References 13 publications

Immunological diagnosis as an adjunctive tool for an early diagnosis of tuberculous meningitis of an immune competent child in a low tuberculosis endemic country: a case report

Immunological diagnosis as an adjunctive tool for an early diagnosis of tuberculous meningitis of an immune competent child in a low tuberculosis endemic country: a case report

Interferon-gamma release assays for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis

The Differential Diagnosis of Hypoglycorrhachia in Adult Patients

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