IMMUNODIAGNOSIS OF TUBERCULOUS MENINGITIS: DETECTION OF ANTIBODY REACTIVITY TO ANTIGENS OFMYCOBACTERIUM TUBERCULOSISANDCYSTICERCUS CELLULOSAEIN CEREBROSPINAL FLUID TUBERCULOUS MENINGITIS PATIENTS BY ELISA

Abstract

Enzyme-linked immunosorbent assay (ELISA) was standardized and evaluated for detection of antibody response in cerebrospinal fluid (CSF) to antigens of Mycobacterium tuberculosis and Cysticercus cellulosae. Sonicated extracts of heat killed M. tuberculosis H37Rv and C. cellulosae were prepared and used in ELISA to detect respective antibody response in CSFs for a definitive diagnosis as to tuberculous meningitis (TBM)/neurocysticercosis (NCC). ELISA was performed in a total of 201 CSF samples, which include Group I: chronic infections of the central nervous system (CNS) with possible diagnosis of TBM, tuberculoma, or NCC (n = 70), and Group II: control group of patients with infectious neurological (n = 19), non-infectious neurological (n = 82), and non-infectious non-neurological conditions, i.e., spinal anaesthesia CSFs (n = 30). Specificity in this study was 99.9% and no true cross-reactivity between antimycobacterial antibodies and C. cellulosae antigens and vice-versa was observed. However, in 17.14% of CSFs (12/70), both antimycobacterial and anticysticercal antibodies were detected, 50% of these cases were diagnosed as TBM. But none of the proven NCC cases showed presence of antimycobacterial antibodies. Results of this study would indicate that it would be beneficial if both antibody and antigen responses are detected in CSFs to infectious aetiologies such as M. tuberculosis, C. cellulosae, and C. neoformans in order to enhance the diagnostic accuracy and proper management, as these diseases are highly endemic in underdeveloped and developing countries.

Assessment of antibody responses to antigens of Mycobacterium tuberculosis and Cysticercus cellulosae in cerebrospinal fluid of chronic meningitis patients for definitive diagnosis as TBM/NCC by passive hemagglutination and immunoblot assays

“…Similarly both anti-mycobacterial and cysticercal antibodies were reactive in some of the CSFs of control group patients (group II c) (Table 1) including GBS, peripheral neuropathy. Even by ELISA these antibodies were detected [21]. Possible explanations for this phenomenon are (i) transudation or exudation of parasitic/bacterial antibodies from systemic circulation through in£amed blood^brain barrier to the CNS [22] and (ii) induction of an immune response to stress proteins of mycobacteria [23], that may have structural homology with that of eukaryotic stress proteins resulting in positive signals.…”

Assessment of antibody responses to antigens ofMycobacterium tuberculosisandCysticercus cellulosaein cerebrospinal fluid of chronic meningitis patients for definitive diagnosis as TBM/NCC by passive hemagglutination and immunoblot assays

“…Similarly both anti‐mycobacterial and cysticercal antibodies were reactive in some of the CSFs of control group patients (group II c) (Table 1) including GBS, peripheral neuropathy. Even by ELISA these antibodies were detected [21]. Possible explanations for this phenomenon are (i) transudation or exudation of parasitic/bacterial antibodies from systemic circulation through inflamed blood–brain barrier to the CNS [22] and (ii) induction of an immune response to stress proteins of mycobacteria [23], that may have structural homology with that of eukaryotic stress proteins resulting in positive signals.…”

Detection of Cysticercus antigens and antibodies in cerbrospinal fluid of patients with chronic meningitis

“…This is important particularly in the area where both tuberculosis and NCC are endemic and make the clinical diagnosis of chronic meningitis most confusing. KATTI & ACHAR 11 have demonstrated both anti-mycobacterial and antiCysticercus antibodies in 17.14% of CSF samples from patients with chronic meningitis. Moreover, cysticercosis may be the underlying etiology associated with chronic meningitis cases especially when other infectious etiology is unknown.…”