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Hussain M, Barman B, Jamil M, Hynniewta Y. Neurotuberculosis: A mystery seeking it's answers in pulmonary tuberculosis. Indian J Tuberc 2024; 71:73-78. [PMID: 38296394 DOI: 10.1016/j.ijtb.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 04/23/2023] [Accepted: 04/28/2023] [Indexed: 02/07/2024]
Abstract
Neurotuberculosis remains a mystery and presents a formidable challenge in diagnosis and management. While pulmonary tuberculosis has a well understood pathophysiology and well researched management strategies, CNS tuberculosis still has plenty of unanswered questions. The purpose of this review is to highlight the debatable issues in the current understanding of the clinical, diagnostic, and therapeutic aspects of Neurotuberculosis.
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Affiliation(s)
| | | | - Md Jamil
- Department of Medicine, AIIMS, Guwahati, India
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Huang TY, Zhang XX, Wu QL, Peng WG, Zheng GL, Cai YM, Pang MC, Wu YE. Antibody detection tests for early diagnosis in tuberculous meningitis. Int J Infect Dis 2016; 48:64-9. [PMID: 27173078 DOI: 10.1016/j.ijid.2016.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/25/2016] [Accepted: 05/04/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Tuberculous meningitis (TBM) is the most severe form of tuberculosis. Microbiological confirmation is rare and treatment is often delayed. Early diagnosis and immediate initiation of treatment are essential for effective TBM control. A systematic review was performed in this study to assess the diagnostic accuracy of detecting antibodies against Mycobacterium tuberculosis in the cerebrospinal fluid (CSF), according to standard methods. Test performance was summarized using a bivariate random-effects meta-analysis. METHODS Studies were identified by a search of the literature, up to July 25, 2015, in the EMBASE and MEDLINE databases via Ovid SP and PubMed. The Cochrane Library was also searched for original, peer-reviewed molecular epidemiology studies that reported the diagnosis of TBM based on antibody detection in the CSF. RESULTS Thirty-six articles (58 studies) were identified. The sensitivity of antibody detection was 0.75 (95% confidence interval (CI) 0.66-0.82), specificity was 0.98 (95% CI 0.96-0.99), and the area under the receiver operating characteristic curve (AUROC) was 0.97 (95% CI 0.95-0.98). By subgroup analysis, the detection of anti-M37Ra was the highest (AUROC 0.99, 95% CI 0.98-1.00), followed by anti-antigen 5 (AUROC 0.99, 95% CI 0.97-0.99) and anti-M37Rv (AUROC 0.97, 95% CI 0.95-0.98). CONCLUSIONS For the early diagnosis of TBM based on antibodies in the CSF, the detection of anti-M37Ra, anti-antigen 5, or anti-M37Rv provides the greatest sensitivity and specificity.
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Affiliation(s)
- T Y Huang
- Department of Laboratory Medicine, the First Affiliated Hospital of Shantou University Medical College, Chang Ping Road, 57, Shantou, Guangdong 515041, China
| | - X X Zhang
- Department of Laboratory Medicine, the First Affiliated Hospital of Shantou University Medical College, Chang Ping Road, 57, Shantou, Guangdong 515041, China
| | - Q L Wu
- Guangdong Key Laboratory of Medical Molecular Imaging, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - W G Peng
- Department of Thoracic Medicine, The Third People's Hospital of Shantou City, Guangdong, China
| | - G L Zheng
- Guangdong Key Laboratory of Medical Molecular Imaging, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Y M Cai
- Department of Laboratory Medicine, the First Affiliated Hospital of Shantou University Medical College, Chang Ping Road, 57, Shantou, Guangdong 515041, China
| | - M C Pang
- Department of Laboratory Medicine, the First Affiliated Hospital of Shantou University Medical College, Chang Ping Road, 57, Shantou, Guangdong 515041, China
| | - Y E Wu
- Department of Laboratory Medicine, the First Affiliated Hospital of Shantou University Medical College, Chang Ping Road, 57, Shantou, Guangdong 515041, China.
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Sahu PS, Parija S, Kumar D, Jayachandran S, Narayan S. Comparative profile of circulating antigenic peptides in CSF, serum & urine from patients with neurocysticercosis diagnosed by immunoblotting. Parasite Immunol 2014; 36:509-21. [PMID: 24965663 DOI: 10.1111/pim.12124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 06/16/2014] [Indexed: 11/28/2022]
Abstract
Traditionally serum and/or CSF specimens have been used for detection of either specific antibodies or antigens as a supportive diagnosis of NCC. However, in recent days, much interest has been shown employing noninvasive specimens such as urine. In our study, we identified and compared a profile of circulating antigenic peptides of parasite origin in three different body fluids (CSF, serum and urine) obtained from confirmed NCC cases and control subjects. The circulating antigenic peptides were resolved by SDS-PAGE and subjected to immunoblotting. For confirmation of their origin as parasite somatic or excretory secretory (ES) material, immunoreactivity was tested employing affinity purified polyclonal Taenia solium metacestode anti-somatic or ES antibodies, respectively. Only lower molecular weight antigenic peptides were found circulating in urine in contrast to serum and CSF specimens. Few somatic peptides were identified to be 100% specific for NCC (19·5 kDa in all three specimens; 131, 70 kDa in CSF and serum only; 128 kDa in CSF only). Similarly, the specific ES peptides detected were 32 kDa (in all three specimens), 16·5 kDa (in serum and CSF only), and 15 kDa (urine only). A test format detecting either one or more of these specific peptides would enhance the sensitivity in diagnosis of NCC.
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Affiliation(s)
- P S Sahu
- Division of Pathology, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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Agarwal AK, Bansal S, Nand V. A Hospital Based Study on Estimation of Adenosine Deaminase Activity (ADA) in Cerebrospinal Fluid (CSF) in Various Types of Meningitis. J Clin Diagn Res 2014; 8:73-6. [PMID: 24701487 PMCID: PMC3972604 DOI: 10.7860/jcdr/2014/7154.4012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 12/15/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Tuberculosis kills 3.70 lakh patients in India every year,out of which 7-12 % are meningeal involvement. Delay in its diagnosis and initiation of treatment results in poor prognosis and squeal in up to 25% of cases. The aim of the present study is to look for a simple, rapid, cost effective, and fairly specific test in differentiating tubercular aetiology from other causes of meningitis. In the present study we measured the adenosine deaminase activity (ADA) in Cerebrospinal Fluid (CSF) of Tubercular Meningitis (TBM) and non-TBM patients. METHODS Fifty six patients attending hospital with symptoms and signs of meningitis were selected and divided into three groups: tubercular, pyogenic, and aseptic meningitis, depending upon the accepted criteria. CSF was drawn and ADA estimated. RESULTS Out of 32 tubercular patients, 28 had CSF-ADA at or above the cut-off value while four had below. Out of 24 non-tuberculous patients (pyogenic and aseptic meningitis), two aseptic meningitis (AM) patient had ADA levels at or above the cut-off value while 22 had below this value. RESULTS of our study indicate that ADA level estimation in CSF is not only of considerable value in the diagnosis of TBM, CSF, and ADA level 10 U/L as a cut-off value with sensitivity 87.5% and specificity 83.33% and positive predictive value of the test was 87.5%.and 83.3% negative predictive value. CONCLUSION It can be concluded that ADA estimation in CSF is not only simple, inexpensive and rapid but also fairly specific method for making a diagnosis of tuberculous aetiology in TBM, especially when there is a dilemma of differentiating the tuberculous aetiology from non-tuberculous ones. For this reason ADA estimation in TBM may find a place as a routine investigation.
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Affiliation(s)
- Ashok Kumar Agarwal
- Senior Resident, Department of Medicine, Rajendra Institute of Medical Science (RIMS), Ranchi, Jharkhand, India
| | - Sonia Bansal
- Microbiologist (Ex-Junior Resident), Department of Microbiology, Rajendra Institute of Medical Science (RIMS), Ranchi, Jharkhand, India
| | - Vidya Nand
- Assistant Professor, Department of Medicine, Rohilkhand Medical College, Bareilly, India
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Parija SC, Gireesh A. Cysticercus cellulosae antigens in the serodiagnosis of neurocysticercosis. Trop Parasitol 2013; 1:64-72. [PMID: 23508242 PMCID: PMC3593475 DOI: 10.4103/2229-5070.86932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 10/31/2011] [Indexed: 11/04/2022] Open
Abstract
Neurocysticercosis (NCC) is difficult to diagnose clinically because of its varied clinical presentation. However, an accurate diagnosis is possible only after suspicion on epidemiological grounds, proper interpretation of the clinical data, analysis of the findings on imaging studies, and specific immunological tests on the serum and cerebrospinal fluid (CSF). The diagnosis of NCC by any single parameter thus continues to remain difficult. In the past, detection of NCC was based on autopsy studies and histological confirmation. In recent times, the advent of imaging methods such as computed tomography and magnetic resonance imaging have provided excellent non-invasive tools for easy detection of NCC. Nevertheless, an imaging technique of the brain, although useful, is not considered as a gold standard for the diagnosis of NCC. Serological tests are being increasingly used in adjunct with imaging techniques, to aid the diagnosis of NCC. Immunodiagnostic techniques include detection methods for specific antibodies and for circulating parasite antigens in the serum and CSF. Currently, many of the immunodiagnostic tests, including the enzyme-linked immunosorbent assay and enzyme immunotransfer blot, use purified native antigens for the immunodiagnosis of NCC. Nevertheless, the main problem with the use of native cysticercal antigens is that the native proteins often show cross reactions with sera from humans infected with other parasites. The preparation of native antigens also demand a constant supply of parasitic material from the intermediate host pig. In order to overcome the problems in using native antigens, the recombinant antigens or synthetic peptides, which can be produced under stable conditions, are being evaluated for the serodiagnosis of NCC.
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Affiliation(s)
- Subhash Chandra Parija
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Ho J, Marais BJ, Gilbert GL, Ralph AP. Diagnosing tuberculous meningitis - have we made any progress? Trop Med Int Health 2013; 18:783-93. [DOI: 10.1111/tmi.12099] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Jennifer Ho
- Centre for Infectious Diseases & Microbiology - Public Health; Westmead Hospital; Sydney; NSW; Australia
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Diagnosis and therapy of tuberculous meningitis in children. Tuberculosis (Edinb) 2012; 92:377-83. [DOI: 10.1016/j.tube.2012.05.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 05/22/2012] [Accepted: 05/29/2012] [Indexed: 11/22/2022]
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Sensitivity and specificity of immunocytochemical staining of mycobacterial antigens in the cytoplasm of cerebrospinal fluid macrophages for diagnosing tuberculous meningitis. J Clin Microbiol 2011; 49:3388-91. [PMID: 21795512 DOI: 10.1128/jcm.01323-11] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The sensitivity and specificity of immunocytochemical staining of mycobacterial antigens in the cytoplasm of cerebrospinal fluid (CSF) macrophages for diagnosis of tuberculous meningitis (TBM) was prospectively compared with Ahuja criteria from 393 consecutive CSF specimens. The assay can play an important role for the diagnosis of TBM, with sensitivity of 73.5% and specificity of 90.7%.
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Katti MK, Chall V, Mahadevan B. A GROUP OF LOW MOLECULAR WEIGHT (<30 kDa) ANTIGENS OF HEAT-KILLED MYCOBACTERIUM TUBERCULOSISH37Rv CONFER BETTER PROTECTION AGAINST EXPERIMENTAL TUBERCULOSIS IN GUINEA PIGS. J Immunoassay Immunochem 2011; 32:128-33. [DOI: 10.1080/15321819.2010.543222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Sahu PS, Parija SC, Narayan SK, Kumar D. Evaluation of an IgG-ELISA strategy using Taenia solium metacestode somatic and excretory-secretory antigens for diagnosis of neurocysticercosis revealing biological stage of the larvae. Acta Trop 2009; 110:38-45. [PMID: 19183550 DOI: 10.1016/j.actatropica.2009.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 12/30/2008] [Accepted: 01/02/2009] [Indexed: 10/21/2022]
Abstract
Diagnosis of neurocysticercosis (NCC) is complicated because of the variability in clinical presentations and course of the disease where viability of parasite is a major determinant. The present study describes evaluation of ELISAs using Taenia solium metacestode somatic and excretory-secretory (ES) antigens for detection of anti-T. solium metacestode IgG antibodies in serum and cerebrospinal fluid (CSF). And results of the ELISAs in cases with a definitive diagnosis of NCC are correlated with the biological stages of the parasite such as live vesicular or degenerated stage. The sensitivity of the IgG-ELISA using ES antigen is observed to be much higher in serum (88.2%) than in CSF (64.28%) although it is only marginally higher in serum (76.4%) than in CSF (75%) when somatic antigen is used in the ELISA. Whereas, the specificities of the ELISA using either somatic or ES antigen for detection of IgG antibodies in serum (97.97%; 96.96%) and CSF (96.42%; 97.61%) are comparable. A strong association is observed between live stage of the parasite and detection of antibodies in sera and CSF from more number of NCC patients by ELISA using ES antigens. Similarly, detection of antibodies by ELISA using somatic antigens could be associated with the dead or degenerated stage of the parasite in brain. The IgG-ELISA strategy developed in the present study opens up an avenue for diagnosis of NCC in hospitals or in population prevalence studies. The use of crude extracts of ES proteins might improve the serodiagnosis of the cases of NCC carrying live vesicular stage of the parasite larvae.
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Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev 2008; 21:243-61, table of contents. [PMID: 18400795 DOI: 10.1128/cmr.00042-07] [Citation(s) in RCA: 358] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tuberculosis of the central nervous system (CNS) is a highly devastating form of tuberculosis, which, even in the setting of appropriate antitubercular therapy, leads to unacceptable levels of morbidity and mortality. Despite the development of promising molecular diagnostic techniques, diagnosis of CNS tuberculosis relies largely on microbiological methods that are insensitive, and as such, CNS tuberculosis remains a formidable diagnostic challenge. Insights into the basic neuropathogenesis of Mycobacterium tuberculosis and the development of an appropriate animal model are desperately needed. The optimal regimen and length of treatment are largely unknown, and with the rising incidence of multidrug-resistant strains of M. tuberculosis, the development of well-tolerated and effective antibiotics remains a continued need. While the most widely used vaccine in the world largely targets this manifestation of tuberculosis, the BCG vaccine has not fulfilled the promise of eliminating CNS tuberculosis. We put forth this review to highlight the current understanding of the neuropathogenesis of M. tuberculosis, to discuss certain epidemiological, clinical, diagnostic, and therapeutic aspects of CNS tuberculosis, and also to underscore the many unmet needs in this important field.
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Mudaliar AV, Kashyap RS, Purohit HJ, Taori GM, Daginawala HF. Detection of 65 kD heat shock protein in cerebrospinal fluid of tuberculous meningitis patients. BMC Neurol 2006; 6:34. [PMID: 16978411 PMCID: PMC1578580 DOI: 10.1186/1471-2377-6-34] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 09/15/2006] [Indexed: 11/10/2022] Open
Abstract
Background Diagnosis of tuberculous meningitis (TBM) is difficult. Rapid confirmatory diagnosis is essential to initiate required therapy. There are very few published reports about the diagnostic significance of 65 kD heat shock protein (hsp) in TBM patients, which is present in a wide range of Mycobacterium tuberculosis species and elicits a cellular and humoral immune response. In the present study we have conducted a prospective evaluation for the demonstration of 65 kD hsp antigen in cerebrospinal fluid (CSF) of TBM patients, by indirect ELISA method using monoclonal antibodies (mAb) against the 65 kD hsp antigen, for the diagnosis of TBM. Methods A total of 160 CSF samples of different groups of patients (confirmed TBM {n = 18}, clinically suspected TBM {n = 62}, non TBM infectious meningitis {n = 35} and non-infectious neurological diseases {n = 45}) were analyzed by indirect ELISA method using mAb to 65 kD hsp antigen. The Kruskal Wallis test (Non-Parametric ANOVA) with the Dunnett post test was used for statistical analysis. Results The indirect ELISA method yielded 84% sensitivity and 90% specificity for the diagnosis of TBM using mAb to 65 kD hsp antigen. The mean absorbance value of 65 kD hsp antigen in TBM patients was [0.70 ± 0.23 (0.23–1.29)], significantly higher than the non-TBM infectious meningitis group [0.32 ± 0.14 (0.12–0.78), P < 0.001] and also higher than the non-infectious neurological disorders group [0.32 ± 0.13 (0.20–0.78), P < 0.001]. A significant difference in the mean absorbance of 65 kD hsp antigen was noted in the CSF of culture-positive TBM patients [0.94 ± 0.18 (0.54–1.29)] when compared with clinically suspected TBM patients [0.64 ± 0.20 (0.23–0.98), P < 0.05]. Conclusion The presence of 65 kD hsp antigen in the CSF of confirmed and suspected cases of TBM would indicate that the selected protein is specific to M. tuberculosis and could be considered as a diagnostic marker for TBM.
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Affiliation(s)
- Anju V Mudaliar
- Biochemistry Research Laboratory, Central India Institute of Medical Sciences, Nagpur – 440 010, India
| | - Rajpal S Kashyap
- Biochemistry Research Laboratory, Central India Institute of Medical Sciences, Nagpur – 440 010, India
| | - Hemant J Purohit
- Environmental Genomics Unit, National Environmental Engineering Research Institute, Nehru Marg, Nagpur-440020, India
| | - Girdhar M Taori
- Biochemistry Research Laboratory, Central India Institute of Medical Sciences, Nagpur – 440 010, India
| | - Hatim F Daginawala
- Biochemistry Research Laboratory, Central India Institute of Medical Sciences, Nagpur – 440 010, India
- Central India Institute of Medical Sciences, 88/2 Bajaj Nagar, Nagpur-440010, India
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Kashyap RS, Kainthla RP, Mudaliar AV, Purohit HJ, Taori GM, Daginawala HF. Cerebrospinal fluid adenosine deaminase activity: a complimentary tool in the early diagnosis of tuberculous meningitis. Cerebrospinal Fluid Res 2006; 3:5. [PMID: 16571142 PMCID: PMC1448186 DOI: 10.1186/1743-8454-3-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Accepted: 03/30/2006] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tuberculous meningitis (TBM) is the commonest form of neurotuberculosis caused by Mycobacterium tuberculosis bacilli (MTB). The diagnosis of TBM is often difficult. A reliable, cost-effective and rapid diagnostic test, which can be performed in any standard pathology laboratory, could be of help in the diagnosis of TBM. In the present study we measured the adenosine deaminase (ADA) activity in cerebrospinal fluid (CSF) of TBM and non-TBM patients. METHOD ADA activity in CSF was determined according to a method based on the Berthlot reaction, which is the formation of a colored indophenol complex from ammonia liberated from adenosine, and quantified spectrophotometrically. RESULTS The CSF ADA activity from TBM patients was compared with CSF ADA from non-TBM infectious meningitis patients, and from patients with non-infectious neurological disorders. The mean CSF ADA activity was found to be significantly higher in CSF of TBM patients, 14.31 +/- 3.87 (2.99-26.94), mean +/- SD with range, than in the CSF from non-TBM infectious meningitis, 9.25 +/- 2.14 (4.99-13.96) and from the non-infectious neurological disorders group, 2.71 +/- 1.96 (0.00-7.68), P < 0.0001 for both comparisons. A cut-off value of 11.39 U/L/min for the TBM patients was calculated from the mean + SD of the non-TBM patients. The ADA test gave a sensitivity of 82% and a specificity of 83% for infectious TBM when this cut-off value was used. CONCLUSION This study demonstrated that ADA activity in the CSF of TBM patients, using a cut-off value 11.39 U/L/min, can be useful for the early differential diagnosis of TBM. This test can be performed in any pathology laboratory where more sophisticated methods are not available.
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Affiliation(s)
- Rajpal S Kashyap
- Biochemistry Research Laboratory, Central India Institute of Medical Sciences, 88/2 Bajaj Nagar, Nagpur-440010, India
| | - Rani P Kainthla
- Biochemistry Research Laboratory, Central India Institute of Medical Sciences, 88/2 Bajaj Nagar, Nagpur-440010, India
| | - Anju V Mudaliar
- Biochemistry Research Laboratory, Central India Institute of Medical Sciences, 88/2 Bajaj Nagar, Nagpur-440010, India
| | - Hemant J Purohit
- Environmental Genomics Unit, NEERI, Nehru Marg, Nagpur-440020, India
| | - Girdhar M Taori
- Biochemistry Research Laboratory, Central India Institute of Medical Sciences, 88/2 Bajaj Nagar, Nagpur-440010, India
| | - Hatim F Daginawala
- Biochemistry Research Laboratory, Central India Institute of Medical Sciences, 88/2 Bajaj Nagar, Nagpur-440010, India
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Casanova CS, Ribeiro MJSP, Gonçalves RR, Faria LC, Peralta JM, Puccioni-Sohler M. Influence of the cerebrospinal fluid laboratory parameters in the ELISA test for neurocysticercosis using a total cysticerci antigen. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 64:55-9. [PMID: 16622554 DOI: 10.1590/s0004-282x2006000100012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To evaluate if the cerebrospinal fluid (CSF) parameters may influence the cysticercosis immunoreactivity response in the CSF. CSF samples of 109 patients were analyzed and classified in three groups, according to the neurological manifestations and the reactivity in antibody-enzyme linked immunosorbent assay (Ab-ELISA) testing in CSF for neurocysticercosis (NC): group A, 18 patients with neurological disorders compatible with NC and reactive Ab-ELISA in CSF for NC; group B, 50 patients with neurological disorders non-compatible with NC and reactive Ab-ELISA for NC; group C, 41 patients with neurological disorders non-compatible with NC and non-reactive Ab-ELISA in CSF for NC. The CSF analysis in group A was compatible with NC. The group B in comparison to the groups A and C presents higher frequency and intensity of hypercytosis, presence of red blood cells in CSF, protein concentration and immunological reactive test for other etiological agents (p<0.05). Based on the present data, we suggest that the inflammatory process and high protein concentration may determine false positive reactions in the Ab-ELISA test for NC in the CSF.
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Affiliation(s)
- Cristiane S Casanova
- Neurology Service, Gaffrèe Guinle University Hospital, Federal University of Rio de Janeiro State, Rio de Janeiro, RJ, Brazil
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Differential diagnosis of tuberculous meningitis from partially-treated pyogenic meningitis by cell ELISA. BMC Neurol 2004; 4:16. [PMID: 15498107 PMCID: PMC529262 DOI: 10.1186/1471-2377-4-16] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2004] [Accepted: 10/22/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculous meningitis (TBM) is a major global health problem, and it is sometimes difficult to perform a differential diagnosis of this disease from other diseases, particularly partially-treated pyogenic meningitis (PTPM). In an earlier study, we demonstrated the presence of a 30-kD protein antigen in cerebrospinal fluid (CSF) of TBM patients. We have also shown that lymphocytes from CSF of TBM patients respond differently to this antigen than do those from PTPM patients. The purpose of this study was to develop an assay that can discriminate between TBM and PTPM. METHODS We developed a cell enzyme-linked immunosorbant assay (Cell ELISA) to quantitatively measure production of antibodies against the 30-kD protein in B cells from CSF of TBM and PTPM patients. RESULTS The cell ELISA yielded 92% (11/12) sensitivity and 92% (11/12) specificity for the differential diagnosis of TBM from PTPM. CONCLUSION When induced with the 30-kD protein antigen, B cells derived from CSF of TBM patients respond to IgG production within 24 h while those derived from PTPM patients do not respond.
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Raether W, Hänel H. Epidemiology, clinical manifestations and diagnosis of zoonotic cestode infections: an update. Parasitol Res 2003; 91:412-38. [PMID: 13680371 DOI: 10.1007/s00436-003-0903-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2003] [Accepted: 05/21/2003] [Indexed: 02/06/2023]
Abstract
This paper reviews the literature on zoonotic cestode infections with specific reference to the years 1999-2003. The sources and prevalence of various zoonotic tapeworm infections caused by adult and larval stages of the genera Taenia, Echinococcus, Diphyllobothrium, Hymenolepis and Dipylidium continue to be an important cause of morbidity and mortality, not only in most underdeveloped countries but also in industrialized countries, particularly in rural areas or among immigrant groups from endemic areas. The review gives a detailed report on recent molecular epidemiological studies on the taxonomy and phylogenetic variations in Echinococcus granulosus, immunological tests and imaging techniques used in epidemiological surveys and clinical investigations of important adult and larval tapeworm infections of animals and humans. Larval stages or metacestodes of Taenia solium, Echinococcus spp. and pseudophyllidean tapeworms (Spirometra syn. Diphyllobothrium spp.) may reside in various tissues of their intermediate hosts, including humans. In particular, Cysticercus cellulosae (T. solium) and the larvae of E. granulosus, and E. multilocularis, which are predominantly located in the liver, lungs and central nervous system forming various types of cysts, lead to a complex of systemic diseases such as cysticercosis, cystic echinococcosis and alveolar echinococcosis, respectively. Relatively rare clinical manifestations are seen in the muscles, subcutaneous tissue, spleen, kidneys, bones and body cavities.
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Affiliation(s)
- W Raether
- Fa Aventis, ADMEP /Q0/10, 65926 Frankfurt am Main, Germany
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Katti MK. Evaluation of current immunodiagnostic criteria for diagnosis of neurocysticercosis. Clin Infect Dis 2003; 37:461-2; author reply 462-3. [PMID: 12884178 DOI: 10.1086/376644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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