Abstract
Objective:To determine diagnostic accuracy of Cerebro Spinal Fluid (CSF) Adenosine De-Aminase (ADA) in detecting Tuberculous Meningitis (TBM) keeping CSF Polymerase Chain Reaction (PCR) for Mycobacterium Deoxy Ribonucleic Acid (DNA) as gold standard.Methods:This cross sectional validation study was conducted at Department of General Medicine of PNS Shifa Naval Hospital Karachi, Pakistan from Oct 2015 to Mar 2017 for a total duration of one and a half year. One hundred and thirty six patients were included. The diagnosis of TBM was based clinically on symptoms like fever, headache, altered mental state and signs of meningeal irritation with CSF findings of increased proteins, low glucose and lymphocytic pleocytosis. Lumbar puncture was done and approximately 4ml of CSF sample was withdrawn for analysis. Diagnosis of TBM was confirmed by doing CSF PCR test for mycobacterium tuberculosis DNA.Results:Total 136 patients were enrolled in this study. Mean age in our study was 47.09±12.80 years, whereas frequency and percentages of male and female patients was 102 (75%) and 34 (25%) respectively. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of CSF ADA level in detecting TBM was 71.32%, 84.21%, 95.45%, 98.97% and 53.85% respectively.Conclusion:The study concludes that diagnostic accuracy of CSF ADA in detecting TBM is high which is proposed as an investigation to differentiate it from other causes of meningitis in places where PCR test is not available.
Highlights
Meningitis is a medical, neurological and sometimes neurosurgical emergency that requires a multi-disciplinary approach
The diagnosis of Tuberculous Meningitis (TBM) was based on symptoms like fever, headache and altered mental state and signs like neck stiffness and positive kerning’s sign with Cerebro Spinal Fluid (CSF) routine examination (R/E) findings of increased proteins, low glucose and lymphocytic pleocytosis
Diagnosis of TBM was confirmed by doing CSF Polymerase Chain Reaction (PCR) test for Mycobacterium TB Deoxy Ribonucleic Acid (DNA)
Summary
Meningitis is a medical, neurological and sometimes neurosurgical emergency that requires a multi-disciplinary approach. Most common types are bacterial, viral and Tuberculous Meningitis (TBM). TBM is more prevalent in the developing countries, especially in socioecomically low status countries.[1] TBM accounts for about 10% of all cases of Tuberculosis (TB) in immunecompetent individuals.[2] According to World Health Organization (WHO) Global Health Observatory Database, TB accounts for 373 cases per 100,000 population in Pakistan.[3]. Jarvis et al in a study conducted in Cape Town, South Africa concluded that 28% cases of the total
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