Frequency-pulsed electron capture gas-liquid chromatography and the tryptophan color test for rapid diagnosis of tuberculous and other forms of lymphocytic meningitis

Immunocytochemical method for early laboratory diagnosis of tuberculous meningitis

A simple immunocytochemical method was standardized for the direct demonstration of mycobacterial antigen in cerebrospinal fluid (CSF) specimens of patients with tuberculous meningitis (TBM). CSF-cytospin smears were prepared from 22 patients with a clinical diagnosis of TBM and also from an equal number of patients with nontuberculous neurological diseases (disease control). Immunocytological demonstration of mycobacterial antigens in the cytoplasm of monocytoid cells was attempted, by using rabbit immunoglobulin G to Mycobacterium tuberculosis as the primary antibody. Of the 22 CSF-cytospin smears from TBM patients, 16 showed positive immunostaining, while all of the CSF-cytospin smears from the disease control showed negative immunostaining for mycobacterial antigen. The technical aspects of this immunocytological method for the demonstration of mycobacterial antigens are simple, rapid, and reproducible, as well as specific, and therefore can be applied for the early diagnosis of TBM, particularly in patients in whom bacteriological methods did not demonstrate the presence of M. tuberculosis in the CSF.

Diagnosis of tuberculous meningitis by detection of tuberculostearic acid in cerebrospinal fluid

Tuberculostearic acid, a structural component of Mycobacterium tuberculosis, was identified by gas chromatography/mass spectrometry with selected ion monitoring in cerebrospinal fluid (CSF) from 13 patients with proven and 8 out of 9 patients with suspected tuberculous meningitis; the negative result was in a patient whose symptoms and CSF abnormalities may have been due to systemic lupus erythematosus. Tuberculostearic acid was found in the CSF of only 1 patient out of 87 with non-tuberculous meningitis or non-infectious disorders; the single false-positive result was probably caused by intrathecal treatment with amikacin. Other aminoglycosides and antituberculous drugs did not interfere with the assay. In serial CSF samples from patients with tuberculous meningitis tuberculostearic acid was still present after 8 months of continuous supervised chemotherapy. Detection of tuberculostearic acid in CSF is a rapid, sensitive, and specific test for tuberculous meningitis, and can be used for retrospective diagnosis in patients who have been started on therapy.

Selective procedures for detecting femtomole quantities of tuberculostearic acid in serum and cerebrospinal fluid by frequency-pulsed electron capture gas-liquid chromatography

Conditions are described for the detection of tuberculostearic acid (10-methyloctadecanoate; C18 X CH3) in cerebrospinal fluid and serum of patients with tuberculous meningitis. C18 X CH3 was found in both the cerebrospinal fluid and serum of patients with tuberculous meningitis at concentrations of 25 to 50 fmol (10(-15) mol). The necessary specificity and sensitivity for detection of C18 X CH3 were obtained by extraction under acid conditions with organic solvent, specific functional group esterification with trichloroethanol, cleanup with disposable reverse-phase sorption chromatography columns, analysis on high-resolution polar and nonpolar capillary columns, and detection by a frequency-pulsed electron capture detector. Use of an IBM 9000 computer equipped with CAP software significantly aided comparison between known C18 X CH3 standards and C18 X CH3 in clinical specimens. Scale expansion and attenuation changes were the major contributions obtained by use of the computer. The data indicate that detection of C18 X CH3 by frequency-pulsed electron capture gas-liquid chromatography may be a valuable aid for early detection of tuberculous meningitis.

Disposable reversed-phase chromatography columns for improved detection of carboxylic acids in body fluids by electron-capture gas-liquid chromatography

Disposable reversed-phase chromatography columns were tested for their effectiveness in removing unreacted trichloroethanol (TCE) from derivatized samples for gas-liquid chromatography analysis. Derivatized acidic chloroform extracts of saponified whole cells of Mycobacterium species, spent culture media, and derivatized acidic chloroform extracts of serum and cerebrospinal fluids from patients with tuberculous meningitis were tested. Samples were added to preconditioned reversed-phase chromatography columns, and various solvents and solvent mixtures were tested to determine maximum recovery of the TCE derivatives. With this procedure, we were able to quickly remove the TCE reagent and efficiently recover TCE-derivatized carboxylic acids. Use of these columns improved the reagent cleanup procedure, simplified the derivatization step, permitted increased detection of trace components, such as tuberculostearic acid, in body fluids, and improved the selectivity of the procedure for detection of carboxylic acids.

Detection of metabolites by frequency-pulsed electron capture gas-liquid chromatography in serum and cerebrospinal fluid of a patient with Nocardia infection

Serum (SR) and cerebrospinal fluid (CSF) from a patient suspected of having tuberculous meningitis were submitted to our laboratory for analysis by frequency-pulsed electron capture gas-liquid chromatography (FPEC GLC). The samples were tested for the presence of carboxylic acids, alcohols, hydroxy acids, and amines by methods described previously (C. C. Alley, J. B. Brooks, and D. S. Kellogg, Jr., J. Clin. Microbiol. 9:97-102, 1977; J. B. Brooks, C. C. Alley, and J. A. Liddle, Anal. Chem. 46:1930-1934, 1974; J. B. Brooks, D. S. Kellogg, Jr., M. E. Shepherd, and C. C. Alley, J. Clin. Microbiol. 11:45-51, 1980; J. B. Brooks, D. S. Kellogg, Jr., M. E. Shepherd, and C. C. Alley, J. Clin. Microbiol. 11:52-58, 1980). The results were different from previous FPEC GLC profiles of SR and CSF from patients with known tuberculous meningitis. Both the SR and CSF contained several unidentified compounds that were not previously detected in tuberculous meningitis or any of our other studies of body fluids. Nocardia brasiliensis was later isolated from the patient. Detection of these metabolites by FPEC GLC could prove to be useful for rapid diagnosis of Nocardia disease, and their identification will provide a better understanding of metabolites produced by Nocardia sp. in vivo.

Frequency-pulsed electron-capture gas-liquid chromatographic studies of chemical changes in sera of patients with schistosomiasis

Sera from well documented cases of Schistosoma mansoni and S. haematobium infections as well as controls, were studied by frequency-pulsed electron-capture gas--liquid chromatography (FPEL-GLC) and mass spectrometry for detection of carboxylic acids and amines. Many carboxylic acids and unidentified peaks were detected. In a few serum specimens from infected patients, putrescine and cadaverine were detected. Indications are that in these few patients with high egg counts enough diamines were present to possibly produce amine toxicity. Following the initial investigation, the basic chloroform extractions, which contained amines, were further studied by FPEC-GLC with the aid of splitless injection and a capillary column. Several amines were detected which seemed to be related to schistosomiasis. Mass spectra were obtained on an unidentified schistosamine peak. The possible significance of the data is discussed.

Identification of diethylene glycol in sera from Egyptian children by frequency-pulsed electron-capture gas-liquid chromatography

Sera taken from fifteen patients (from Kerdasa village near Cairo, Egypt) infected with Schistosoma haematobium, with eggs present in the urine, were studied by frequency-pulsed electron-capture gas-liquid chromatography (FPEC-GLC). Some of the patients were treated with metrifonate and again studied by FPEC-GLC. Diethylene glycol was detected in the sera of untreated patients infected with S. haematobium. This compound was identified by negative chemical ionization and electron-impact mass spectrometry. Initially we suspected that the build-up of diethylene glycol in these patients was caused by schistosomiasis infection. However, in a follow-up blind-coded study using FPEC-GLC, which included 37 sera from Kerdasa and Tamooh villages near Cairo, Egypt, we detected diethylene glycol in eleven samples, four of which were controls from the villages. These latter findings indicate that the source of diethylene glycol might be the environment or foodstuffs, but the specific source has not been determined. Regardless of the source, diethylene glycol could affect the health of these Egyptian children by causing a narcotic effect, increased bladder stones, and increased numbers of bladder tumours.

Analysis of fatty acids of the genus Rochalimaea by electron capture gas chromatography: detection of nonanoic acid

The fatty acid compositions of Rochalimaea quintana, strains Fuller and Guadalupe, and R. vinsonii, the Canadian vole agent, were determined in an effort to further characterize these bacteria. The cells were saponified with 5% NaOH in 50% methanol and acidified to pH 2. The methanolysates were extracted with chloroform, derivatized with 2,2,2-trichloroethanol, and analyzed using a Hewlett-Packard gas chromatograph equipped with a frequency pulse-modulated electron capture detector and a 3% OV-101 packed-glass column. The fatty acid profiles of the three Rochalimaea strains were similar, with octadecenoic acid (C18:1) the most abundant, followed by octadecanoic (C18:0) and hexadecanoic (C16:0) acids. Moderate to trace amounts of other acids were also present. Unexpectedly, well-defined peaks of nonanoic acid (C9) were found consistently. A portion of this acid, but not all, was extractable with chloroform. Since C9 is not reported as a usual component of bacteria and most analyses do not include a search for this fatty acid, this study was extended to three strains of Legionella and one of Campylobacter. Comparable results were obtained. Since these bacteria were grown in complex media which contain some C9, it is possible that the medium is the source of bacterial C9. Whether this compound can be synthesized by the bacteria remains to be investigated.

Studies of metabolic changes in cell cultures infected with four serotypes of dengue fever viruses by frequency-pulsed electron-capture gas-liquid chromatography

Monkey kidney cell cultures were infected with four serotypes of dengue viruses, and the supernatant fluids of the cell cultures were extracted for amines, alcohols, carboxylic acids, and hydroxy acids. The derivatized extracts were then analyzed by frequency-pulsed electron-capture gas-liquid chromatography (FPEC-GLC). FPEC-GLC profiles of the hydroxy acids showed peaks that were different for different serotypes and the FPEC-GLC carboxylic acid profiles differed from the control medium. These differences were reproducible when the same lot for medium was used. There were differences in profiles between lots of control media due apparently to different fetal bovine sera used in the growth medium. Therefore, the same lot of medium was necessary to reproduce profiles. The data obtained from the study indicate that FPEC-GLC can be used to detect changes in cellular metabolism caused by viral infection, and that these metabolic changes might be useful in detection of genetic differences in viruses as reflected by detectable changes in the metabolism of the infected cell.

Rapid and reliable techniques for the laboratory detection of bacterial meningitis

Microorganisms encountered in cerebrospinal fluid require rapid and accurate means of detection and identification in the laboratory. Although restricted to morphologic study and Gram reaction, the Gram stain of cerebrospinal fluid has been the primary diagnostic tool for preliminary diagnosis of purulent meningitis, with identification of the etiologic agent often made within one to two hours by direct microscopic examination. Gram stain and appropriate culture procedures still provide the basis for comparing other diagnostic methods. Nonimmunologic methods that show promise in being both rapid and reliable include gas-liquid chromatography and the Limulus amebocyte lysate test. Fatty acid and carbohydrate profiles characteristic of Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis, and Staphylococcus aureus in the cerebrospinal fluid of human subjects and animals have been obtained by gas-liquid chromatography. Also, a unique compound has been detected by gas-liquid chromatography in cerebrospinal fluid from patients with tuberculous meningitis. The Limulus test has been reliable in spinal fluid and almost always gives positive results in H. influenzae and other Gram-negative meningitides. Nonspecific test procedures of varying degrees of accuracy and promise include lactic acid, C-reactive protein, and lactate dehydrogenase determination. Direct microscopic examination of cerebrospinal fluid remains the most practical and accurate method for identifying the etiologic basis of bacterial (and fungal) meningitis.

Gas-chromatographic detection of urinary tract infections caused by Escherichia coli and Klebsiella sp

A gas-chromatographic method for the diagnosis of urinary tract infections caused by Escherichia coli and Klebsiella sp. is described. A total of 96 urine samples from individuals with clinical symptoms of urinary tract infection or pyrexia of unknown origin were tested by conventional and gas-chromatographic methods for bacteriuria. The gas-chromatographic method showed complete agreement with the conventional method in diagnosing all of 16 cases of bacteriuria caused by E. coli and 4 cases caused by Klebsiella sp. The remaining two cases of bacteriuria, caused by other bacteria, were not detected by the gas-chromatographic method.

Rapid differentiation of rocky mountain spotted fever from chickenpox, measles, and enterovirus infections and bacterial meningitis by frequency-pulsed electron capture gas-liquid chromatographic analysis of sera

Normal sera and sera from patients with Rocky Mountain spotted fever, chickenpox, enterovirus infections, measles, and Neisseria meningitidis infections were extracted with organic solvents under acidic and basic conditions and then derivatized with trichloroethanol or heptafluorobutyric anhydride-ethanol to form electron-capturing derivatives of organic acids, alcohols, and amines. The derivatives were analyzed by frequency-pulsed electron capture gas-liquid chromatography (FPEC-GLC). There were unique differences in the FPEC-GLC profiles of sera obtained from patients with these respective diseases. With Rocky Mountain spotted fever patients, typical profiles were detected as early as 1 day after onset of disease and before antibody could be detected in the serum. Rapid diagnosis of Rocky Mountain spotted fever by FPEC-GLC could permit early and effective therapy, thus preventing many deaths from this disease.