CSF ADA Determination in Early Diagnosis of Tuberculous Meningitis in HIV-Infected Patients.

Gopal Chandra Ghosh,B B Gupta,Brijesh Sharma

doi:10.1155/2016/5820823

Gopal Chandra Ghosh, B B Gupta + Show 1 more

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https://doi.org/10.1155/2016/5820823

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Journal: Scientifica	Publication Date: Jan 1, 2016
Citations: 23	License type: CC BY 4.0

Affiliation: Christian Medical College

Abstract

Tuberculous and Cryptococcal meningitis are common in HIV patients. A highly specific and sensitive rapid test for diagnosis of Tuberculous meningitis especially in setting of HIV is not available in developing countries where the burden of disease is high. We measured ADA (adenosine deaminase) levels using spectrophotometric method in the CSF of HIV patients with meningitis to differentiate Tuberculous meningitis from meningitis due to other causes. Kruskal-Wallis test was used to compare ADA values between tuberculous meningitis (TBM) and nontuberculous (non-TB) meningitis patients and a receiver-operating characteristic (ROC) analysis curve was drawn from these values. Levels of ADA in the CSF of patients with TBM were significantly higher than those in patients with meningitis due to other causes. CSF ADA level determination with a cut-off value of 6 IU/L was found to be highly specific and fairly sensitive test for the diagnosis of TBM in HIV positive patients.

Highlights

Tuberculous meningitis (TBM) is an endemic disease in developing countries [1], more so in patients with a low socioeconomic status
(1) Mycobacterium tuberculosis detected in Cerebrospinal fluid tuberculous meningitis (TBM) (CSF) by ZiehlNeelsen staining or polymerase chain reaction for Mycobacterium tuberculosis or
Posttest probability was high at ADA value of 6 IU/L and receiveroperating characteristic (ROC) curves analysis of ADA levels in TBM and non-TBM groups revealed area under curve (AUC) of .958 (Figures 2 and 3)

Summary

Introduction

Tuberculous meningitis (TBM) is an endemic disease in developing countries [1], more so in patients with a low socioeconomic status. Five lakh patients die of tuberculosis every year in India [4]. Studies from India have reported HIV seropositivity rates in patients with tuberculosis to be between 0.4 and 20.1% [6]. 50% of HIV-infected patients in India are coinfected with M. tuberculosis and approximately 200,000 of these coinfected persons will develop active tuberculosis each year in association with HIV infection [7]. Mortality is significantly higher in HIV-infected patients with tuberculous meningitis (63.3%) as compared to HIV negative patients (17.5%) [8]. Methods of diagnosis of TBM have been found to have low sensitivity and specificity [9]

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Results

Conclusion