Cerebrospinal Fluid Adenosine Deaminase Levels Research Articles

Study of the Role of Cerebrospinal Fluid C-reactive Protein and Adenosine Deaminase to differentiate Various Types of Meningitis.

(1) To study cerebrospinal fluid (CSF) adenosine deaminase (ADA) and CSF C-reactive protein (CRP) levels in the differentiation of viral, pyogenic, and tuberculous meningitis (TBM). (2) To estimate the borderline levels of CRP in CSF in viral, pyogenic, and TBM. A prospective and cross-sectional study was conducted at the Department of Medicine, SRN Hospital, Prayagraj, Uttar Pradesh, India, between August 2016 and September 2018. In this study, a total of 100 patients with meningitis were included applying specific inclusion and exclusion criteria after proper ethical approval. Out of 100 patients, 61 were TBM, 31 were pyogenic meningitis, and eight were viral meningitis (VM). CSF CRP level was significantly increased in pyogenic meningitis (1.05 ± 0.36 mg/dL) compared to nonpyogenic meningitis [TBM (0.42 ± 0.13 mg/dL) and VM (0.37 ± 0.09 mg/dL)]. At the cut-off level of CRP in CSF > 0.6 mg/dL, its diagnostic sensitivity in pyogenic meningitis was 93.55% and specificity 94.20%. While CSF ADA levels were higher in the TBM group (13.32 ± 3.21 U/L) compared to the other two groups [pyogenic meningitis (6.15 ± 1.27 U/L) and VM (4.86 ± 0.88 U/L)]. At a cut-off, CSF ADA level of >10 U/L, its diagnostic sensitivity for TBM was 91.67% and specificity 90%. Cerebrospinal fluid (CSF) CRP levels were found to be raised in pyogenic meningitis, and CSF ADA was found to be elevated in TBM. While both ADA level and CRP level in CSF are found low in VM.

Stroke in Tuberculous Meningitis and Its correlation with Magnetic Resonance Angiography Manifestations.

Objective  The primary objective of the study was to assess the location of cerebral infarction and look for corresponding magnetic resonance angiography (MRA) changes in patients with tuberculous meningitis (TBM). We also evaluated the predictors of ischemic stroke in TBM and the impact of these infarctions on patient's outcome. Methods  This was a single-center prospective study between September 2018 and September 2020. Demographic and laboratory parameters were noted. Cranial magnetic resonance imaging and MRA were performed at the time of admission to the hospital. Results  Among 120 patients with TBM, 46 had stroke. Nineteen (15.8%) patients died, of which 12 (10%) suffered from stroke. The most common site of infarction was the basal ganglia (54.3%). The commonest site of MRA abnormalities was the middle cerebral artery (39.1%). British Medical Research Council (BMRC) stage 3, cerebrospinal fluid (CSF) sugar, CSF adenosine deaminase (ADA) level, basal exudates, hydrocephalus, and hyponatremia were found to be predictors of stroke in TBM, while BMRC stage 3, CSF cell count, CSF ADA level, and anemia were found to be significantly associated with mortality in TBM patients with stroke. Conclusion  The basal ganglia were the most common site of ischemic stroke in TBM, and middle cerebral artery was the most often involved intracranial blood vessel. BMRC stage 3 was significantly associated with both stroke and mortality in TBM patients with stroke.

Epidemiology of patients with central nervous system infections, mainly neurosurgical patients: a retrospective study from 2012 to 2019 in a teaching hospital in China

BackgroundCentral nervous system (CNS) infections are relatively rare but are associated with high mortality worldwide. Empirical antimicrobial therapy is crucial for the survival of patients with CNS infections, and should be based on the knowledge of the pathogen distribution and antibiotic sensitivities. The aim of this study was to investigate the features of pathogens in patients with CNS infections in North China and evaluate the risk factors for mortality and multi-drug-resistant (MDR) bacterial infections.MethodsA retrospective study was conducted with patients with positive cerebrospinal fluid (CSF) cultures in a teaching hospital from January 2012 to December 2019. The following data were collected: demographic characteristics, laboratory data, causative organisms and antimicrobial sensitivity results. Data were analyzed with SPSS 16.0. Univariate analysis and binary logistic regression analyses were performed to identify the risk factors for mortality and MDR bacterial infections.ResultsA total of 72 patients were diagnosed with CNS infections, and 86 isolates were identified. The proportions of Gram-positive bacteria, Gram-negative bacteria and fungi were 59.3, 30.2 and 10.5%, respectively. The predominant Gram-positive bacteria was Coagulase-negative Staphylococci. Acinetobacter baumannii, Escherichia coli and Klebsiella spp. were the predominant Gram-negative bacteria. Compared to 2012–2015 years, the proportion of Gram-negative bacteria increased markedly during 2016–2019 years. Coagulase-negative Staphylococci, Streptococcus pneumoniae and Enterococcus faecium had 100% sensitivity to vancomycin, teicoplanin and linezolid. Acinetobacter baumannii and Klebsiella pneumoniae were 100% sensitive to tigecycline. Escherichia coli had 100% sensitivity to amikacin, meropenem and imipenem. The overall mortality rate in the 72 patients was 30.6%. In multivariate analysis, age > 50 years, pulmonary infections and CSF glucose level < the normal value were associated with poor outcomes. CSF adenosine deaminase level > the normal value and the presence of external ventricular drainage/lumbar cistern drainage were associated with MDR bacterial infections.ConclusionsThe mortality rate due to CNS infections reached 30.6% in our study. The proportion of Gram-negative bacteria has increased markedly in recent years. We should give particular attention to patients with risk factors for mortality and MDR bacterial infections mentioned above.

Cerebrospinal fluid adenosine deaminase level as a diagnostic marker in adult tuberculous meningitis: a study conducted in a tertiary care hospital of Eastern India

Background: Tubercular meningitis is one of the highly prevalent form of meningitis in the world and is a significant cause of morbidity and mortality in developing countries like India. Lack of early and timely diagnosis and subsequent initiation of treatment makes the fatality rate even higher. Cerebrospinal fluid (CSF) analysis is most important aspect of lab diagnosis in tuberculous meningitis (TBM) worldwide. The objective of this study was to study the cerebrospinal fluid CSF adenosine deaminase (ADA) levels in TBM and non-TBM meningitis cases and to determine its diagnostic significance as a biochemical marker of TBM infection.Methods: The study population comprised three different patient groups. TBM (n=36), pyogenic meningitis (n=17) and aseptic meningitis group (n=12). Total 75 subjects were enrolled consecutively in the study and CSF specimens were collected from them. ADA and other cytological and biochemical estimation were carried out using standard protocol.Results: ADA level in TBM in compare to non-TBM was more and mean ADA level of TBM, AM and PM are 26.423±3.8, 2.602±0.5 and 6.29±0.3 respectively. There are highly significant differences between the TBM and non-TBM groups and also in compare with individual groups.Conclusions: CSF ADA levels are elevated in the TBM cases as compared to the non-TBM - meningitis cases.  Results are statistically significant. It is a simple and inexpensive diagnostic adjunctive test in the rapid and early diagnosis of TBM.

Adenosine deaminase, an aid in the diagnosis of tubercular meningitis – hospital based study

Introduction: Tubercular meningitis (TBM) is the most prevalent and most grave form of extrapulmonary tuberculosis. It is associated with high mortality rate. The confounding factor for this is the delay in diagnosing the disease and initiation of treatment. The present study aims to look for the diagnostic utility of ADA estimations in Tubercular meningitis patients. Materials and Methods: For this study the patients with the signs and symptoms of meningitis and attending our hospital within a st ipulated period of one year approximately, were taken as subjects. As per the accepted criteria, the patients were segregated into two broad groups: tubercular meningitis cases and nontubercular meningitis cases. CSF specimens were collected and ADA levels were estimated on semiautoanalyser in the laboratory. Results: Out of 31 patients of tubercular meningitis, 27 showed ADA levels above 10 U/L while 2 showed lower values. On the other hand 32 cases of non- tubercular meningitis showed ADA levels below 10 U/L and 4 showed higher values, thereby supporting the fact that ADA evaluation in CSF is of substantial value in diagnosing TBM. It also illustrious that if CSF ADA value of 10 U/L is taken as bench mark then the sensitivity for diagnosing TBM is 93.10% and specificity is 88.87% which is fairly good. Conclusion: Therefore, just by evaluating CSF ADA levels we can diagnose the TBM cases with respectably good sensitivity and high specificity and consuming least time and resources. Therefore, ADA estimation is a valuable adjunct to routine investigations in diagnosis of TBM. Keywords: Tubercular Meningitis (TBM), Cerebrospinal fluid (CSF), Adenosine Deaminase (ADA).

Clinical study of meningitis in children and role of adenosine deaminase in differentiating tubercular from non-tubercular meningitis

Background: In diseases where cell mediated immunity plays an important role like in tuberculosis, CSF (Cerebrospinal fluid) adenosine deaminase (ADA) activity is increased. Hence, this testing is done especially among children with suspected tubercular meningitis. The objective of this was to study role of Adenosine Deaminase in differentiating tubercular from non-tubercular meningitis.Methods: This was a hospital based cross sectional study was carried out among 50 children of proven meningitis for a period of two years. CSF ADA levels were done for all cases. They were divided into tubercular meningitis and non-tubercular meningitis group and compared.Results: Incidence of tuberculous meningitis (TBM) was found high in the age group 5-8 years. Male:female ratio was 2.3:1. Fever was present in all cases followed by vomiting and neck rigidity. CSF AFB was positive in 3 cases (6%). Neuroimaging was done in all cases in which 3 patients had basal exudate in which 2 patients had TBM and 1 patient was Non-TBM. 3 patients had hydrocephalus in MRI in which 2 had TBM diagnosed and 1 had non-TBM. As per ADA levels, 10 were diagnosed as TBM out of which 8 patients had ADA level ≥10 IU/L and 2 had ADA level &lt;10 IU/L which was missed by ADA and later confirmed by other modalities.Conclusions: It was concluded that if ADA level in CSF is ≥10IU/l the diagnosis of TBM should be considered.

Meningitis-retention syndrome: Clinical features, frequency and prognosis

BackgroundMeningitis-retention syndrome (MRS) is a peculiar combination of aseptic meningitis (AM) and acute urinary retention without other neurological symptoms. MRS has not been well recognised, and the prevalence of MRS in patients with AM is unknown. ObjectiveTo investigate the frequency and clinical features of MRS. MethodsClinical and laboratory features of patients with MRS who were consecutively admitted to the Chiba Rosai Hospital between 2009 and 2017. ResultsOf the 37 patients with AM, MRS was observed in three (8%). In MRS patients, the mean latency between the onset of meningeal symptoms (headache and/or fever) and the three clinical course milestones (the onset of voiding difficulty, urinary retention and recovery of no residual urine volume) were 8, 9.3 and 18 days, respectively. Patients with MRS frequently showed elevated cerebrospinal fluid adenosine deaminase levels and decreased cerebrospinal fluid/serum glucose ratios. All patients with MRS recovered without a specific treatment, and the mean hospital stay was 18 days. ConclusionsMRS may be more common than is generally considered. The long-term prognosis of MRS was good, and it was a self-limiting condition. However, it is likely to be underreported or misdiagnosed. Therefore, it is important to recognise that patients with AM may have MRS.

Diagnostic accuracy of cerebrospinal fluid adenosine deaminase in detecting Tuberculous Meningitis.

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.

[Cerebrospinal fluid adenosine deaminase and its dynamic changes in tuberculous meningitis].

Objective: To explore the diagnostic value of cerebrospinal fluid (CSF) adenosine deaminase (ADA) level in tuberculous meningitis. Methods: We retrospectively analyzed 139 patients (73 males, 66 females) who visited Beijing Chest Hospital for suspected TBM from January 2010 to June 2015. Of them, 99 patients were diagnosed to have TBM, with 45 males and 54 females, and a mean age of (33±15) years. Forty patients were diagnosed as having Non-TBM, with 28 males and 12 females, and a mean age of (35±18) years. All patients underwent lumbar puncture, and CSF ADA, routine, biochemical and bacteriological tests were performed. Thirty-five TBM patients reviewed CSF ADA test after treatment for 4 weeks, 8 weeks and 6 months. Results: The level of CSF ADA in TBM group was higher than that in the non-TBM group, the difference being statistically significant (5.6 U/L vs 2.3 U/L, P=0.000). When the cut-off value of the CSF ADA was 3.8 U/L , the sensitivity and specificity for diagnosis of TBM were 60.6% (95%CI 50.3%-70.1%) and 87.5% (95%CI 72.4%-95.3%), respectively, and the area under the ROC curve was 0.734.The CSF ADA level was (6.7±4.2) U/L in the 35 cases of TBM before treatment. After 4 weeks, 8 weeks and 6 months of anti-tuberculosis treatment, the CSF ADA levels were (4.5±3.3) U/L, (3.7±2.7) U/L and (2.0±1.5) U/L, respectively; all significantly decreased as compared to that before treatment (P<0.001). There was no significant change in the ADA level between 8 weeks and 4 weeks (P=0.128). After 6 months of treatment, the level of CSF ADA was significantly lower than those after 4 and 8 weeks' treatment (P<0.001). Conclusions: CSF ADA in TBM patients was significantly higher than in non-TBM patients. The sensitivity of CSF ADA level in the diagnosis of TBM was poor, but the specificity was better. CSF ADA was significantly reduced and showed dynamic changes with effective anti-tuberculosis treatment and maybe helpful in evaluating the effect of treatment.

Study of adenosine deaminase levels in Tb meningitis and its comparision with other types of meningitis

Tubercular meningitis is a type of septic meningitis and is a significant cause of morbidity and mortality in developing countries like India due to lack of early and timely diagnosis and so the case of fatality remains higher. Cerebrospinal fluid (CSF) evaluation is single most important aspect of lab diagnosis in meningitis. Aims: 1. To evaluate the diagnostic significance of CSF adenosine deaminase (ADA) activity in tuberculous meningitis. 2. To compare the values of CSF ADA in different types of meningitis and with that of controls. Materials and Methods: It was clinical cross-sectional study of 25 cases of tuberculosis, 25 cases of pyogenic meningitis, and 25 cases of aseptic meningitis. Twenty five controls with age and sex matched individuals without evidence of any neurological diseases served as control for CSF ADA. Results: In this study of 100 patients, 25 (100%) patients of the tubercular group had CSF ADA levels of more than 10 IU/dL with a mean of 13.68 IU/dL with 80% of the patients having ADA levels between 11 and 15 IU/dL. Mean ADA levels of aseptic meningitis was 8.00 IU/dL, pyogenic was 5.76 IU/dL, and control group had mean ADA of 2.12 IU/dL. Conclusion: All patients with tuberculous meningitis had elevated CSF ADA activity. CSF ADA activity in tuberculous meningitis was significantly higher when compared with pyogenic meningitis, aseptic meningitis, and controls.

Role of multiplex polymerase chain reaction in diagnosing tubercular meningitis.

Tuberculous meningitis (TBM) is one of the most serious manifestations of extrapulmonary tuberculosis. Timely and accurate diagnosis provides a favorable prognosis in patients with TBM. The study evaluated the use of multiplex polymerase chain reaction (PCR) in the diagnosis of TBM. A study was conducted on 74 patients clinically suspected with TBM. The cerebrospinal fluid (CSF) specimens were processed for smear microscopy, middle brook 7H9 culture, and multiplex PCR using primers directed against IS6110 gene and 38 kD protein for detection of Mycobacterium tuberculosis. The results were analyzed to assess the role of multiplex PCR in the diagnosis of TBM. A total of 26 (35.1%) patients were diagnosed with TBM. Microscopy was negative in all while culture was positive in two cases only. Comparing with clinical diagnosis and CSF adenosine deaminase levels of ≥10 U/L, multiplex PCR showed sensitivity, specificity, positive predictive value, and negative predictive value of 71.4%, 89.6%, 83.3%, and 81.2%, respectively, in the diagnosis of TBM.

Comparative analysis of cerebrospinal fluid adenosine deaminase levels in infective meningitis of different aetiologies

Background: Meningitis can be caused by bacteria, viruses, parasites, and fungi as well as by non-infectious conditions including inflammatory disorders (e.g., systemic lupus erythematosis or Kawasaki disease) and neoplasia (e.g., leukemic meningitis). The objective of this study were to study cerebrospinal fluid (CSF) adenosine deaminase (ADA) levels in infective meningitis of different aetiologies. And to assess the role of cerebrospinal fluids (CSF) adenosine deaminase (ADA) levels in differentiating tubercular from non-tubercular meningitis.Methods: The study was conducted on 70 patients of meningitis at Postgraduate Department of Paediatrics, in G. B. Pant Hospital, an associated hospital of Government Medical College Srinagar. Out of 70 patients included in the study 27 cases were Aseptic Meningitis (AM), 14 cases partially treated pyogenic -meningitis (PTM), 19 cases pyogenic meningitis (PM), and 10 cases were tubercular meningitis (TBM). ADA activity of CSF was quantified by colorimetry.Results: In our study we observed a significant high level of ADA 30.0±3.2U/L (20.0, 54.0) among the tubercular meningitis (TBM) patients and its respective level among Aseptic Meningitis (AM), was 8.1±0.3U/L (4.0, 11.5), partially treated pyo -meningitis (PTM) was 7.6±0.4U/L (5.0, 11.0), pyogenic meningitis (PM) was 11.6±0.5U/L (8.0, 14.5). In total Non-TBM ADA level was 9.1±0.3U/L (4.0, 14.5) units/liter. At cut off of &gt; or equal to 10U/L sensitivity was 100% specificity66.67% positive predictive value33.33% negative predictive value of 100% diagnostic accuracy 71.43%. At a higher cut off of &gt; or equal to 12U/L sensitivity was 100% and specificity increased to 81.67% positive predictive value 47.62% negative predictive value100% diagnostic accuracy was 84.29%.Conclusions: The sensitivity and specificity of CSF ADA activity is markedly high in differentiating TBM from non-TBM. Hence CSF ADA activity may be used as a simple, cost-effective and reliable test for early diagnosis of TBM.

Role of cerebrospinal fluid adenosine deaminase activity in the diagnosis of tuberculous meningitis in children

Background: Early and correct treatment is essential for successful outcome in patients of tuberculous men-ingitis. Adenosine deaminase activity in the cerebrospinal fluid has been found to be a simple and useful investigation in the diagnosis of tuberculous meningitis in children.Methods: It is a cross sectional observational hospital based study conducted at the Department of Paediatrics, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad, India. Children aged 2 months to 12 years were included in the study during April 2016 to October 2016.Results: The mean value of adenosine deaminase activity in the cerebrospinal fluid of tuberculous meningitis cases was 13.3±14.49. The mean cerebrospinal fluid adenosine deaminase levels in tuberculous meningitis patients was significantly higher than non-tuberculous meningitis patients with P &lt;0.01.Conclusions: The mean cerebrospinal fluid adenosine deaminase level was significantly raised in tuberculous meningitis patients.

Cross sectional study of 39 Cases of Tuberculous Meningitis in North Bihar

Abstract Background: Tuberculous meningitis (TBM) is the most severe manifestation of extrapulmonary tuberculosis with a high mortality and morbidity rates. Exact prevalence of Central nervous system tuberculosis in India is not known, but it accounts for an estimated 1% of all cases of TB, which equates to around 17000 cases in India in 2014. The aims of the study are (1) to review the clinical, laboratory, disease staging and radiological findings of 39 TBM cases at a single center. (2) to present the local epidemiological data from our cases. Methods: Thirty -nine patients admitted to our tertiary hospital with symptoms and signs of meningitis were selected and on the basis of adopted criteria labeled as tuberculous meningitis. Clinical profile, disease staging and cerebrospinal fluid (CSF) findings noted in each patient. adenosine deaminase (ADA) level in CSF estimated. Cut off value of ADA kept at or above 10 IU/L for tubercular meningitis. Comparative study done with 23 patients of pyogenic meningitis. Results: The mean age of patients with tubercular meningitis was 39.07 ± 16.67 years. The symptom duration range from 7 to 98 days with a median of 28 days. Clinically fever was present in 37 (94.8 %), headache in 29 (74.3 %), and vomiting in 22 (56.4 %) patients. Six (15.38 %) patients had seizure. On CSF cytological and biochemical analysis the mean total white blood cell count was 256.74 ± 184.03 /cmm, mean protein 182.22 ± 113.12 mg/ dl and mean sugar 52.85 ± 19.3. The CSF / Blood glucose ratio in TBM case was 0.41. Out of 39 TBM patients, 33 patients were found to be having CSF ADA at or above the cutoff value of 10 IU/L while six had below cutoff value. On comparison between two groups, the CSF ADA level found to be highly significant (P < 0.001). On cranial CT or MRI 28.2 % patients had hydrocephalous, 7.6 % with tuberculoma and 5.1 % with spinal arachnoiditis. About one third patients had evidence of active tuberculosis on chest X-ray. Conclusions: Any patient presenting either acutely or chronically with signs and symptoms of meningitis, urgent CSF examination should be done to diagnose tuberculous meningitis on the basis of CSF lymphocytic pleocytosis, decreased glucose, increased protein, and ADA more than 10 IU/L. Because of high mortality and morbidity early initiation of antitubercular drugs may prevent sequel.

Raised adenosine deaminase in the cerebrospinal fluid: A tool for the diagnosis of tuberculous meningitis in developing countries.

The rapid diagnosis followed by the early treatment of tuberculous meningitis (TBM) is important in preventing fatal outcomes. The mainstay of diagnosis lies in cerebrospinal fluid (CSF) analysis, radiological investigations, and clinical findings. The present study was conducted to determine the efficacy, sensitivity, and specificity of raised adenosine deaminase (ADA) level in CSF to differentiate TBM from non-TBM cases as a rapid, cost-effective, and noninvasive test. This was a retrospective study conducted over a 1-year period in a tertiary teaching institute of Malwa region, India. A total of 143 patients presented with symptoms and signs of meningitis were included and divided into TBM and non-TBM groups on the basis of the diagnostic criteria. CSF ADA estimation was drafted and analyzed by using ≥10 U/L as a cutoff value. A statistical comparison of the ADA levels between the study groups was made by using unpaired Student's t-test. Out of the 143 cases, 40 were TBM, and 103 were non-TBM. The mean ADA level in TBM and non-TBM cases was 17.18 ± 9.59 and 6.33 ± 2.48, respectively, and the difference was statistically significant. Using a cutoff level ≥10 U/L, CSF ADA had a sensitivity of 92.5% and a specificity of 89.32%. Positive and negative likelihood ratios of the test were 8.66 and 0.08, respectively, and positive and negative predictive values, were 77.08 and 96.84%, respectively. The present study reflects the importance of a CSF ADA level ≥10 U/L in the diagnosis of TBM. Thus, it can be used as an adjunctive diagnostic tool to differentiate TBM from other non-TBM cases, when there is a diagnostic dilemma.

Tuberculous Meningitis-Mimicking Varicella-Zoster Meningitis.

BackgroundVaricella-zoster virus (VZV) is one of the most common etiologies of aseptic meningitis. The severest manifestation of VZV meningitis is occasionally confused with tuberculous meningitis (TBM). Thus, we investigated the clinical manifestations of VZV meningitis as compared with those of TBM.Materials and MethodsAll adult patients who were diagnosed with VZV meningitis or TBM were enrolled at a tertiary hospital in Seoul, South Korea, during an 8-year period. The clinical characteristics and cerebrospinal fluid (CSF) profile of patients were analyzed.ResultsSeventy-nine patients with VZV meningitis and 24 patients with TBM were enrolled in this study. Of the 79 patients with VZV meningitis, 63 (80%) did not received empirical anti-tuberculous therapy (Group 1) and the remaining 16 (20%) received empirical anti-tuberculous therapy (Group 2), compared with 24 patients with TBM (Group 3). Altered mental status, intensive care unit (ICU) admission, neurologic sequelae, CSF protein levels, and CSF adenosine deaminase levels revealed a trend of being higher in Group 3 than Group 2, which was higher than Group 1. However, the CSF/serum glucose ratio was significantly lower in Group 3 than in Group 1 or Group 2.ConclusionAbout one fifth of VZV meningitis cases presented as severe manifestations, mimicking TBM. The CSF/serum glucose ratio might be useful to differentiate VZV meningitis from TBM until definite diagnostic tests are available. Physicians should keep in mind that a differential diagnosis between severe VZV meningitis and TBM is needed.

Cryptococcal meningitis associated with increased adenosine deaminase in the cerebrospinal fluid.

Introduction Clinically, increased cerebrospinal fluid (CSF) adenosine deaminase (ADA) level is an important diagnostic clue of tuberculous meningitis. However, increased CSF ADA level can be caused by other neurological diseases.Case descriptionWe report a case of a 67-year-old woman with cryptococcal meningitis presented with increased ADA level of the CSF. In parallel with her recovery, the ADA level of CSF decreased steadily. This is the first case described the chronological change in CSF ADA level of the patient with cryptococcal meningitis in detail.Discussion and EvaluationClinically, increased CSF ADA level is an important diagnostic clue of tuberculous meningitis. However, previously, it was reported that increased CSF ADA level can be caused by other neurological diseases. In this case, the patient was diagnosed with cryptococcal meningitis, and the possibility of coinfection with tuberculous meningitis has been discarded by the negative PCR, negative cultures and the clinical course. In addition, the chronological change in CSF ADA level was useful for follow-up assessment.ConclusionsCryptococcal meningitis should be considered for the differential diagnosis for diseases presented increased CSF ADA.

Cystic Mesenteric Inflammatory Pseudotumor Associated to Multidrug-Resistant Meningeal Tuberculosis and a Cerebrospinal Fluid Shunt: An Unusual Case

Abdominal masses in childhood have a very large spectrum of benign and malignant causes. Inflammatory pseudotumor (IP) arising from intra-abdominal sites has only rarely been designated previously in children. We report the case of a 21-year-old HIV-negative man, in whom a cystic mesenteric IP appeared after 46 months of diagnosis of tuberculous meningitis (TBM) complicated with brain infarcts, tuberculoma, hydrocephalus and multiple neurosurgical procedures including ventriculoperitoneal (VP) cerebrospinal fluid (CSF) shunt placement, shunt exchanges and endoscopic ventricular septostomies. At diagnosis, primary antituberculous drugs were administered and mycobacterial CSF cultures were persistently negative; nevertheless, follow-up elevated adenosine deaminase levels in CSF suggested multidrug-resistant (MDR) tuberculosis and moxifloxacin and aminoglycoside were added with improvement. Repeated formation of abdominal cystic masses with shunt obstructions, abdominal distention and pain lead us to conclude that the peritoneum was no longer useful for CSF derivation and a ventriculo-atrial shunt was placed. After laparoscopic excision of an abdominal mass, microscopic examination showed a cystic tumor formed by proliferation of fibroblasts, myofibroblasts and inflammatory cells. Focally a granuloma with multinucleated giant cells (Langerhans cells) was observed and Ziehl-Neelsen staining showed acid-fast bacilli. Diagnosis of IP associated to MDR tuberculosis was made. This complication is probably under-recognized since histopathological study of abdominal masses related with CSF VP shunts is not performed systematically. Our case illustrates the importance of microscopic tissue examination to detect MDR and extensively drug-resistant (XDR) tuberculosis and the difficult treatment of these cases. J Neurol Res. 2015;5(3):225-229 doi: http://dx.doi.org/10.14740/jnr333w

Simultaneous estimation of serum and cerebrospinal fluid adenosine deaminase level to differentiate tuberculous and non-tuberculous meningitis

Introduction: Studies have shown the role of cerebrospinal fluid (CSF) adenosine deaminase (ADA) level but simultaneously estimation of serum and CSF-ADA to diagnose tuberculous meningitis (TBM) has been assessed rarely. Therefore, we conducted this study to assess the usefulness of serum and CSF-ADA in diagnosing TBM and to differentiate it with non-tuberculous meningitis in children. Material &amp; Methods: A prospective, case-control study was conducted in tertiary care institution of central India over one year. Children hospitalised with suspected meningitis were recruited and serum and CSF-ADA levels were estimated after dividing them into TBM and non-tuberculous meningitis. Results: Out of 78 recruited cases, 36 had TBM while 42 had non-tuberculous etiology. 32 of 36 TBM cases had CSF-ADA above cut-off value (10U/L) while only 3 out of 42 controls had levels above this. Serum ADA above cut-off (60U/L) was seen in 13 TBM and 2 non-TBM cases. Mean CSF-ADA in cases (18.68±6.21 U/L) was significantly higher than in controls (5.98±2.75 U/L) (p&lt;0.0001); however, serum ADA did not differ significantly between two groups (p=0.0631). CSF-ADA &gt;10U/L showed 92.86% sensitivity and 88.89% specificity (area under ROC curve - 0.9742) in differentiating tuberculous from non-tuberculous meningitis; it also has 91.43% positive predictive value and 90.70% negative predictive value. Serum ADA &gt;60IU/L has shown sensitivity of 95.24% with poor specificity of 33.33%. Conclusion: CSF-ADA estimation is of considerable value to diagnose TBM and to differentiate it from non-tuberculous meningitis but simultaneous estimation of CSF and serum ADA has no additional benefit.

Cerebrospinal fluid adenosine deaminase levels as a diagnostic marker in tuberculous meningitis in adult Nepalese patients

ObjectiveTo study the cerebrospinal fluid (CSF) adenosine deaminase (ADA) levels in tuberculous meningitis (TBM) and non-TBM -viral meningitis cases and to determine its diagnostic significance as a biochemical marker of TBM infection. MethodsThe study population comprised two different patient groups. TBM – group I – 28 cases and non-TBM-viral meningitis – 22 cases. These were enrolled consecutively in the study and CSF speci mens were collected from them. ADA estimation was carried out by spectrophotometry. ResultsADA levels (mean±SD) in the TBM and non-TBM groups were 16.46±6.24 U/L and 5.13±2.96 U/L, respectively (highly significant P < 0.001). Using a CSF ADA cut off reference value of >10 IU/L, the test showed a good sensitivity of 82.14% (95%CI 64.41–92.12) and a high specificity of 90.91% (95%CI 72.19–97.47). Positive and negative predictive value and positive and negative likelihood ratios and accuracy of the test in TBM cases were 92% (95%CI 75.03–97.77), 80% (95%CI 60.86–91.13), 9.03 (95%CI 2.38–34.25), 0.19 (95%CI 0.09–0.44) and 86%, respectively. ConclusionCSF ADA levels are elevated in the TBM cases as compared to the non-TBM – viral meningitis cases with a good sensitivity and a high specificity. It is a simple and inexpensive diagnostic adjunctive test in the rapid and early diagnosis of TBM.