Journal Article

Rapid Diagnosis of Tuberculous Meningitis by T Cell—Based Assays on Peripheral Blood and Cerebrospinal Fluid Mononuclear Cells

Sung-Han Kim, Oh-Hyun Cho, Su-Jin Park, Eun Mi Lee, Mi-Na Kim, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Jun Hee Woo, Sang-Ahm Lee and Joong Koo Kang

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 10, pages 1349-1358
Published in print May 2010 | ISSN: 1058-4838
Published online May 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/652142
Rapid Diagnosis of Tuberculous Meningitis by T Cell—Based Assays on Peripheral Blood and Cerebrospinal Fluid Mononuclear Cells

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Background. The role of the new Myocbacterium tuberculosis–specific enzyme-linked immunosorbent spot (ELISPOT) assay for diagnosis of tuberculous meningitis (TBM) has not yet been fully assessed. Here, we conducted a prospective, blinded, observational study to evaluate the diagnostic accuracy of this assay, compared with the conventional tests, for diagnosing TBM.

Methods. All adult patients with suspected TBM were enrolled at a tertiary care hospital (Seoul, South Korea) during a 12-month period. ELISPOT assays were performed on peripheral mononuclear cells and mononuclear cells from cerebrospinal fluid (CSF).

Results. Eighty-nine patients with suspected TBM were enrolled. Of these, 31 (35%) were classified as having TBM (10 confirmed, 6 highly probable, and 15 probable cases), and 55 (62%) were classified as not having active tuberculosis. The remaining 3 (3%) with possible TBM were excluded from the final analysis. The sensitivities and specificities, respectively, of the tested methods for diagnosing TBM were as follows: CSF adenosine deaminase level >5.8 U/L, 89% (95% confidence interval [CI], 69%–98%) and 73% (95% CI, 58%–84%); peripheral mononuclear cells ELISPOT, 71% (95% CI, 51%–86%) and 57% (95% CI, 42%–70%); and CSF mononuclear cells ELISPOT assay, 59% (95% CI, 36%–79%) and 89% (95% CI, 72%–98%). The combined sensitivity of an adenosine deaminase level >5.8 U/L or a positive peripheral mononuclear cells ELISPOT assay result was 94% (95% CI, 79%–99%), conferring a negative likelihood ratio of 0.14 (95% CI, 0.03–0.55) when both test results were negative.

Conclusion. ELISPOT assays using peripheral mononuclear cells and CSF mononuclear cells are useful adjuncts to the current tests for diagnosing TBM, particularly when used in combination with the assessment of adenosine deaminase level in CSF.

Journal Article.  4348 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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