T-cell-based assays on cerebrospinal fluid and PBMCs for rapid diagnosis of TB meningitis in non-HIV patients

Interferon-Gamma Release Assay Performance of Cerebrospinal Fluid and Peripheral Blood in Tuberculous Meningitis in China

“…However, the sensitivity and the SFCs of CSF T-SPOT.TB were much lower than those of PB T-SPOT.TB. These results were in line with previous findings for TBM [19, 30] but are lower than those on pleural fluid or bronchoalveolar lavage fluid [15, 29]. We assumed that the possible reason of lower sensitivity and enumeration of antigen-specific T cells could be the protective effect of blood-brain barrier (BBB).…”

“…In recent years, a small number of studies have evaluated the T-SPOT.TB test on CSF for TBM diagnosis. However, the sample size of these studies was not large enough, and the sensitivity and specificity were controversial and varied in the range of 40–92% and 75–100% [17–19]. Furthermore, the study that evaluated the T-SPOT.TB test on CSF in high-burden setting, such as China, was limited.…”

A diagnostic algorithm for tuberculous pleurisy using the ELISPOT assay on peripheral blood and pleural effusion

“…[7][8][9] Previous studies of the compartmentalization of TB-specific T lymphocytes, which expand clonally and are recruited preferentially to sites of primary infection such as the cerebrospinal [10,11] and peritoneal [12,13] fluids rather than to peripheral blood, have suggested a useful, non-invasive algorithm for diagnosing active extrapulmonary TB infection. Several groups have evaluated the diagnostic performance of the ELISPOT assay for TB pleurisy, using peripheral blood and pleural fluid.…”

Methods of Rapid Diagnosis for the Etiology of Meningitis in Adults

“…One Korean study of HIV-negative patients (25 with definite or probable TBM and 57 classified as not having TBM by clinical characteristics) showed a sensitivity of 72% (95% CI: 51–88%) and specificity of 79% (95% CI: 66–89%) [96], the same group published a study 2 years prior with 59% sensitivity (95% CI: 36–79%) and specificity of 89% (95% CI: 72–98%) [97]. A South African study of 86 patients (87% HIV positive), 38 with TBM by culture or PCR (median CD4: 84; IQR: 53–173) and 48 classified as non-TBM (median CD4: 161; IQR: 54–261) showed sensitivity of 84% (95% CI: 69–94%) and specificity of 73% (58–85%) [98].…”

“…This is an important study as IGRAs rely to some degree on T-cell function, yet despite advanced HIV infection, the IGRA was relatively sensitive. All studies had high numbers of inconclusive results and different cut-points with the same assay (T-spot: 6 vs 20 positive spots) [96–97]. IGRA are currently relatively expensive, requires overnight processing and specialized equipment [98] limiting the utility of IGRA for TBM at present.…”