Differential diagnosis of tuberculous meningitis from partially-treated pyogenic meningitis by cell ELISA

Kashyap, Rajpal S.; Kainthla, Rani P; Satpute, Ravindra M; Agarwal, Neha; Chandak, Nitin H.; Purohit, Hemant J.; Taori, Girdhar M.; Daginawala, Hatim F.

doi:10.1186/1471-2377-4-16

Cited by 20 publications

(17 citation statements)

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“…This 30-kDa protein was later proved to be a specific antigen of M. tuberculosis and could be considered a diagnostic marker for TBM (11). The production of antibodies against the 30-kDa protein in CSF was adopted for use for the differential diagnosis of TBM in partially treated patients with pyogenic meningitis by a cell-based enzyme-linked immunosorbent assay (cell ELISA) with a sensitivity of 92% (12).…”

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confidence: 99%

Comparative Evaluation of Early Diagnosis of Tuberculous Meningitis by Different Assays

et al. 2006

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Cerebrospinal fluid (CSF) and peripheral blood (PBL) were sampled multiple times from 25 patients with a clinical diagnosis of tuberculous meningitis (TBM) and 49 controls, including 27 patients with other infectious diseases of the central nervous system and 22 patients with other noninfectious neurological diseases. We used an enzyme-linked immunospot assay (ELISPOT) to detect anti-Mycobacterium bovis BCG antibody-secreting cells in CSF and PBL, PCR to detect a repeated insertion sequence (IS6110) specific for Mycobacterium tuberculosis in CSF, and an enzyme-linked immunosorbent assay (ELISA) to detect anti-BCG antibodies in CSF and PBL. In the meantime, culture of CSF from every TBM and control patient was done on Lowenstein-Jensen medium. ELISPOT proved to be the most valuable test, with a sensitivity of 84.0% and a specificity of 91.8%, and showed a sensitivity of 100.0% with the CSF specimens obtained within 4 weeks after the onset of TBM. The numbers of CSF anti-BCG immunoglobulin-secreting cells tested by ELISPOT were even higher in the early phase of TBM and declined while the disease was going on (P ‫؍‬ 0.008), which allowed an early diagnosis to be made. The sensitivities of PCR and ELISA were only 75.0% and 52.3%, respectively; and the specificities were 93.7% and 91.6%, respectively. Culture of CSF on Lowenstein-Jensen medium was the least sensitive (16%) compared to the sensitivities of the other three assays. Our results demonstrate that the ELISPOT technique is worthy for routine use in the laboratory to support the clinical diagnosis of TBM.In the past several years there has been a global increase in the incidence of tuberculosis along with the prevalence of AIDS and the emergence of multidrug-resistant strains. Tuberculous meningitis (TBM) is a major global health problem and is the most severe form of extrapulmonary tuberculosis, with a high rate mortality. TBM is diagnosed on the basis of clinical features, cerebrospinal fluid (CSF) studies, and radiological findings. Due to the variable clinical presentations and CSF findings, which can be confused with those of other chronic infections of the central nervous system (CNS), TBM is sometimes difficult to diagnosis with certainty, especially in its early phase (about 1 to 2 weeks after onset, according to our clinical observations). During this time period, the typical clinical manifestations of TBM have not fully developed. The polymorphonuclear pleocytosis in CSF can occur early and may give an erroneous impression of bacterial meningitis. Also during this time period, the antibiotic or antituberculous treatment has lasted for just a short time, and the effect of therapy is not obvious enough to be able to make a judgment. The contrast enhancement of the basal cisterns, hydrocephalus, or lesions in the brain parenchyma on a computed tomography (CT) image or a magnetic resonance imaging image specific for TBM may not occur so early. Previous clinical studies have clearly demonstrated that the timing of the onset of chemotherapy is the most cr...

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Comparative Evaluation of Early Diagnosis of Tuberculous Meningitis by Different Assays

et al. 2006

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“…Sin embargo, es importante recordar que otras situaciones clínicas como la meningitis bacteriana aguda parcialmente tratada, que no fue incluida en este estudio, pueden constituir parte del diagnóstico diferencial de la MTBC 28 . Como principal limitante del presente estudio no se incluyeron pacientes cursando tuberculosis en otras localizaciones (extra-meníngeas) ni se tuvo acceso a historia clínica que permitiese evaluar el antecedente de infección tuberculosa pasada, vacunación BCG o la presencia de…”

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Comparación de adenosina deaminasa y detección de anticuerpos anti-antígeno A60 para el diagnóstico de meningitis tuberculosa

García

Bahamondes²,

Reyes

et al. 2012

Rev. chil. infectol.

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“…Irreversible brain damage may result while waiting for confirming the diagnosis. Delay in diagnosis and treatment are regarded as a major contributing factors to the morbidity and mortality [15]. Biochemical analysis reveals a significant increase in protein concentration in the tuberculous and pyogenic meningitis [4,16].…”

Section: Discussionmentioning

confidence: 99%

CSF Proteins as Discreminatory Markers of Tubercular and Pyogenic Meningitis

Shekhar

Rao²,

Ka³

et al. 2013

JCDR

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Differential diagnosis of tuberculous meningitis from partially-treated pyogenic meningitis by cell ELISA

Cited by 20 publications

References 20 publications

Comparative Evaluation of Early Diagnosis of Tuberculous Meningitis by Different Assays

Comparative Evaluation of Early Diagnosis of Tuberculous Meningitis by Different Assays

Comparación de adenosina deaminasa y detección de anticuerpos anti-antígeno A60 para el diagnóstico de meningitis tuberculosa

CSF Proteins as Discreminatory Markers of Tubercular and Pyogenic Meningitis

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