Abstract

To the Editors: Recently, two studies have shown that an ELISPOT assay using mononuclear cells (MCs) compartmentalised in the cerebrospinal fluid (CSF) is an accurate and rapid rule-out or rule-in test for tuberculosis meningitis (TBM) in conjunction with other rapid tests [1, 2]. However, these two studies had limitations: the majority (94%) of enrolled patients were infected with HIV in one study [2], and the CSF-MC ELISPOT assay was performed on a relatively small number of patients in the other [1]. This study builds on our earlier publication [1] and evaluates the clinical utility for the diagnosis of TBM of simultaneous testing with the peripheral blood mononuclear cell (PBMC) and CSF-MC ELISPOT assays in a larger number of non-HIV-infected patients, by using the standardised diagnostic criteria for TBM [3]. Adult patients (aged ≥16 yrs) with suspected TBM admitted to Asan Medical Center, a 2,700-bed tertiary hospital in Seoul, Republic of Korea, were enrolled prospectively from April 2008 to October 2010. The results of the ELISPOT assays were concealed from the attending physicians to avoid bias because the results of the ELISPOT assays might have affected the attending physicians' decisions on empirical anti-tuberculosis therapy. Patients with suspected TBM were categorised as definite TBM, probable TBM, possible TBM, not TBM or indeterminate meningitis, according to a recently proposed uniform case definition, with some modifications (tables s1 and s2) [3]. We excluded patients with possible TBM or indeterminate meningitis from the …

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