The rapid and sensitive diagnosis of tuberculous meningitis by the detection of tuberculostearic acid in cerebrospinal fluid using gas chromatography-mass spectrometry with selective ion monitoring

Tuberculostearic acid incorporated predictive model contributes to the clinical diagnosis of tuberculous meningitis

“…In the mycobacterial plasma membrane (PM), palmitic (16:0), oleic (18:1), and tuberculostearic (19:0) acid constitute the major fatty acid components, in which TBSA is capable to regulate lateral membrane partitioning of intracellular membrane domain 29 and highly related to Mtb existence in host. 20 In this study, we considered the advantages of TBSA for sensitive (83.3%–100%) and specific (98.9%–100%) TBM diagnosis, 17 , 18 , 19 , 30 and avoided solely usage of TBSA results that may cause false-positive diagnosis. 31 Hence, co-diagnostic factors were further screened from multiple parameters.…”

“…In the past, while some indirect molecular indices such as Mtb-specific antibodies, and interferon-gamma release assays (IGRAs) level in cerebrospinal fluid (CSF) 13 , 14 have been reported to be valuable for TBM diagnosis, yet a near-direct biomarker, tuberculostearic acid (TBSA), was overlooked in the past two decades, 15 which showed 83.3%–100% sensitivity and 98.9%–100% specificity, and could be rapidly detected by gas-chromatography/mass spectrometry (GC/MS) in 1–2 days from last century’s studies. 16 , 17 , 18 , 19 It was known that TBSA, a mycobacterial origin lipid marker, is currently thought as a good candidate to indicate Mtb burden by lipidomics within a day in non-CNS infection, 20 but unexpectedly, not in TBM.…”

Novel approaches to the diagnosis of mycobacterial infections

“…TSA is present not only in mycobacteria but also in other micro-organisms which constitute the normal microbial flora in various body sites. Hence, this method is unsuitable for the diagnosis of TB in sputum and other nonsterile specimens, because of low specificity [9], but the application of GC/MS may hold some promise for the diagnosis of extrapulmonary TB [10][11][12]. However, the expensive equipment and the specialized staff required for GC/MS limit the value of this technique.…”

Expression and characterization of Rv0447c product, potentially the methyltransferase involved in tuberculostearic acid biosynthesis in Mycobacterium tuberculosis

“…Tuberculostearic acid (10-methylstearic-acid; TSA) is a significant lipid constituent of the mycobacterial cell wall [4,5] and is thought to be a clinical marker of the disease [6,7]. TSA is found to be attached by covalent bonds to the virulence determinants such as phosphatidylinositolmannosides (PIMs), lipoarabinomannan (LAM), and related cell wall glycolipids.…”