Diagnosis Of Tuberculosis Meningitis Research Articles

Pediatric sellar-suprasellar tuberculosis: A case report and review of the literature

Background: Pediatric sellar-suprasellar tuberculosis is a rare form of tuberculosis that affects the pituitary gland and surrounding areas in the brain. It can be difficult to diagnose based on clinical and radiological signs alone, as they can be similar to other pituitary masses. A combination of biological, hormonal, and imaging examinations can aid in making an accurate diagnosis. It is important to consider tuberculosis in the differential diagnosis of sellar-suprasellar masses in the pediatric population, especially in areas with a high prevalence of tuberculosis. Case Description: A 17-year-old male with no history of illness showed up with a series of symptoms, including headaches and vision problems. A sellar-suprasellar lesion was seen on imaging, along with several minor lesions. The diagnosis of tuberculosis meningitis with cerebral and pituitary tuberculoma was made after cerebrospinal fluid analysis revealed the presence of tuberculosis. Treatment with anti-tuberculosis drugs led to clinical improvement and lesion resolution. Conclusion: Children’s sellar tuberculomas can be difficult to diagnose since they resemble other pituitary tumors. It is essential to take them into account in the differential diagnosis, especially in regions with a high incidence of tuberculosis. Long-term chemotherapy is the recommended course of treatment, and monthly follow-up visits are necessary to check hormone levels and evaluate whether a permanent hormone replacement is necessary.

Microbiological diagnosis and mortality of tuberculosis meningitis: Systematic review and meta-analysis.

Tuberculosis (TB) which is caused by Mycobacterium tuberculosis poses a significant public health global treat. Tuberculosis meningitis (TBM) accounts for approximately 1% of all active TB cases. The diagnosis of Tuberculosis meningitis is notably difficult due to its rapid onset, nonspecific symptoms, and the difficulty of detecting Mycobacterium tuberculosis in cerebrospinal fluid (CSF). In 2019, 78,200 adults died of TB meningitis. This study aimed to assess the microbiological diagnosis TB meningitis using CSF and estimated the risk of death from TBM. Relevant electronic databases and gray literature sources were searched for studies that reported presumed TBM patients. The quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal tools designed for prevalence studies. Data were summarized using Microsoft excel ver 16. The proportion of culture confirmed TBM, prevalence of drug resistance and risk of death were calculated using the random-effect model. Stata version 16.0 was used perform the statistical analysis. Moreover, subgroup analysis was conducted. After systematic searching and quality assessment, 31 studies were included in the final analysis. Ninety percent of the included studies were retrospective studies in design. The overall pooled estimates of CSF culture positive TBM was 29.72% (95% CI; 21.42-38.02). The pooled prevalence of MDR-TB among culture positive TBM cases was 5.19% (95% CI; 3.12-7.25). While, the proportion of INH mono-resistance was 9.37% (95% CI; 7.03-11.71). The pooled estimate of case fatality rate among confirmed TBM cases was 20.42% (95%CI; 14.81-26.03). Based on sub group analysis, the pooled case fatality rate among HIV positive and HIV negative TBM individuals was 53.39% (95%CI; 40.55-66.24) and 21.65% (95%CI;4.27-39.03) respectively. Definite diagnosis of TBM still remains global treat. Microbiological confirmation of TBM is not always achievable. Early microbiological confirmation of TBM has great importance to reduce mortality. There was high rate of MDR-TB among confirmed TBM patients. All TB meningitis isolates should be cultured and drug susceptibility tested using standard techniques.

Missed Opportunities in the Diagnosis of Tuberculosis Meningitis.

Tuberculosis meningitis (TBM) has high mortality and morbidity. Diagnostic delays can impact TBM outcomes. We aimed to estimate the number of potentially missed opportunities (MOs) to diagnose TBM and determine its impact on 90-day mortality. This is a retrospective cohort of adult patients with a central nervous system (CNS) TB International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) diagnosis code (013*, A17*) identified in the Healthcare Cost and Utilization Project, State Inpatient and State Emergency Department (ED) Databases from 8 states. Missed opportunity was defined as composite of ICD-9/10 diagnosis/procedure codes that included CNS signs/symptoms, systemic illness, or non-CNS TB diagnosis during a hospital/ED visit 180 days before the index TBM admission. Demographics, comorbidities, admission characteristics, mortality, and admission costs were compared between those with and without a MO, and 90-day in-hospital mortality, using univariate and multivariable analyses. Of 893 patients with TBM, median age at diagnosis was 50 years (interquartile range, 37-64), 61.3% were male, and 35.2% had Medicaid as primary payer. Overall, 407 (45.6%) had a prior hospital or ED visit with an MO code. In-hospital 90-day mortality was not different between those with and without an MO, regardless of the MO coded during an ED visit (13.7% vs 15.2%, P = .73) or a hospitalization (28.2% vs 30.9%, P = .74). Independent risk of 90-day in-hospital mortality was associated with older age, hyponatremia (relative risk [RR], 1.62; 95% confidence interval [CI], 1.1-2.4; P = .01), septicemia (RR, 1.6; 95% CI, 1.03-2.45; P = .03), and mechanical ventilation (RR, 3.4; 95% CI, 2.25-5.3; P < .001) during the index admission. Approximately half the patients coded for TBM had a hospital or ED visit in the previous 6 months meeting the MO definition. We found no association between having an MO for TBM and 90-day in-hospital mortality.

Diagnostic and Prognostic Value of Cerebrospinal Fluid Lactate and Glucose in HIV-Associated Tuberculosis Meningitis.

ABSTRACTThe role of cerebrospinal fluid (CSF) lactate in tuberculosis meningitis (TBM) diagnosis and prognosis is unclear. The aim of this study was to evaluate the performance of CSF lactate alone and in combination with CSF glucose in predicting a diagnosis of TBM and 14-day survival. HIV-positive Ugandan adults were investigated for suspected meningitis. The baseline CSF tests included smear microscopy; Gram stain; cell count; protein; and point-of-care glucose, lactate, and cryptococcal antigen (CrAg) assays. Where CrAg was negative or there was suspicion of TBM, a CSF Xpert MTB/RIF Ultra (Xpert Ultra) test was performed. We recorded baseline demographic and clinical data and 2-week outcomes. Of 667 patients, 25% (n = 166) had TBM, and of these, 49 had definite, 47 probable, and 70 possible TBM. CSF lactate was higher in patients with definite TBM (8.0 mmol/L; interquartile ratio [IQR], 6.1 to 9.8 mmol/L) than in those with probable TBM (3.4 [IQR, 2.5 to 7.0] mmol/L), possible TBM (2.6 [IQR 2.1 to 3.8] mmol/L), and non-TBM disease (3.5 [IQR 2.5 to 5.0] mmol/L). A 2-fold increase in CSF lactate was associated with 8-fold increased odds of definite TBM (odds ratio, 8.3; 95% confidence interval [CI], 3.6 to 19.1; P < 0.01) and 2-fold increased odds of definite/probable TBM (odds ratio, 2.3; 95% CI, 1.4 to 3.7; P < 0.001). At a cut point of >5.5 mmol/L, CSF lactate could be used to diagnose definite TBM with a sensitivity of 87.7%, specificity of 80.7%, and a negative predictive value of 98.8%. CSF lactate was not predictive of 2-week mortality.IMPORTANCE Tuberculosis meningitis (TBM) is the most severe form of tuberculosis, and its fatality is largely due to delays in diagnosis. The role of CSF lactate has not been evaluated in patients with HIV presenting with signs and symptoms of meningitis. In this study, using a point-of-care handheld lactate machine in patients with HIV-associated meningitis, we showed that high baseline CSF lactate (>5.5 mmol) may be used to rapidly identify patients with TBM and shorten the time to initiate treatment with a similar performance to the Xpert Ultra assay for definite TBM. Elevated CSF lactate levels, however, were not associated with increased 2-week mortality in patients with HIV-associated TBM. Due to moderate specificity, other etiologies of meningitis should be investigated.

Comparative diagnostic utility of metagenomic next-generation sequencing, GeneXpert, modified Ziehl-Neelsen staining, and culture using cerebrospinal fluid for tuberculous meningitis: Amulti-center, retrospective study in China.

BackgroundEarly diagnosis of tuberculosis meningitis (TBM) remains a great challenge during clinical practice. The diagnostic efficacies of cerebrospinal fluid (CSF)‐based mycobacterial growth indicator tube (MGIT) culture, modified Ziehl–Neelsen (ZN) staining, Xpert MTB/RIF, and metagenomic next‐generation sequencing (mNGS) for TBM remained elusive.MethodsA total of 216 adult patients with suspicious TBM were retrospectively enrolled in this multi‐cohort study. The diagnostic performances for MGIT, modified ZN staining, Xpert MTB/RIF, and mNGS using CSF samples were evaluated.ResultsUniform clinical case definition classified 88 (40.7%) out of 216 patients as the definite TBM, 5 (2.3%) patients as probable TBM cases, and 24 (11.1%) patients as possible TBM cases. The sensitivities of MGIT, modified ZN staining, Xpert MTB/RIF, and mNGS for TBM diagnosis against consensus uniform case definition for definite TBM were 25.0%, 76.1%, 73.9%, and 84.1%, respectively. Negative predictive values (NPVs) were 66.0%, 85.9%, 84.8%, and 90.1%, respectively. The sensitivities of MGIT, modified ZN staining, Xpert MTB/RIF, and mNGS for TBM diagnosis against consensus uniform case definition for definite, probable, and possible TBM were 18.8%, 57.3%, 55.5%, and 63.2%, respectively. Negative predictive values (NPVs) were 51.0%, 66.4%, 65.6%, and 69.7%, respectively. mNGS combined with modified ZN stain and Xpert could cover TBM cases against a composite microbiological reference standard, yielding 100% specificity and 100% NPV.ConclusionMetagenomic next‐generation sequencing detected TBM with higher sensitivity than Xpert, ZN staining and MGIT culture, but mNGS cannot be used as a rule‐out test. mNGS combined with Xpert or modified ZN staining could enhance the sensitivity of diagnostic tests for TBM.

Comparison of Polymerase Chain Reaction With Fluorescent Microscopy for Detecting Pulmonary Tuberculosis in Smear-Negative Sputum Samples in Quetta, Pakistan

Background: One of the common clinical manifestations of extra-pulmonary tuberculosis is tuberculous meningitis (TBM). New methods, which are simple and effective, are necessary for early diagnosis of TBM. Objective: This study aimed to assess the use of fluorescence microscopy and polymerase chain reaction (PCR) techniques targeting pncA and IS6110. PCR is a fast and reliable technique for diagnosing tuberculosis (TB), particularly in paucibacillary specimens such as smear-negative sputum for diagnosing patients with Mycobacterium tuberculosis. Materials and Methods: The pncA and IS6110 multiplex-PCR methods were applied to analyze sputum using a specific pair of primers designed to amplify the insertion sequence, pncA, and IS6110 in the M. tuberculosis genome. A total of 200 sputum samples were collected from patients with TB. Out of 200 patients, 54.0% (n=108) and 46.0% (n=92) were males and females at Fatima Jinnah General and Chest Hospital, Quetta, respectively. Results: M. tuberculosis was detected as 15 (16.3%) and 18 (16.7%) for pncA and IS6110 using PCR and fluorescence microscopy, respectively. M. tuberculosis DNA detected by PCR and smear-negative fluorescence microscopy was 16.50% (n=33) and 14.70% (n=18), respectively. In other words, PCR assay detected the increased prevalence of M. tuberculosis. Risk factors revealed high exposure to receiving TB infection which was associated with urban areas (OR=1.07, 95% CI: 0.34–3.35), TB in family (OR=1.22, 95% CI: 0.38-3.88), over crowdedness (OR=2.93, 95% CI: 0.37-23.7), malnutrition (OR: 1.39; 95% CI: 0.52-3.74), and rural areas (OR: 1.54, 95% CI: 0.72-3.31). Conclusion: A wide range of molecular assays are now being developed and reviewed for detecting TB. We conclude that the use of pncA and IS6110 PCR assays is beneficial in the quick diagnosis of TB meningitis.

Rapid Diagnosis of Tuberculosis Meningitis by Detecting Mycobacterium tuberculosis Cell-Free DNA in Cerebrospinal Fluid.

Tuberculosis meningitis (TBM) is one of the most severe forms of tuberculosis. However, TBM diagnosis is quite challenging due to nonspecific clinical presentation and the paucity of the pathogen in cerebrospinal fluid (CSF) samples. In this study, we report a new method for detecting cell-free Mycobacterium tuberculosis DNA (cf-TB) in CSF and evaluate its clinical value for TBM diagnosis. Of 68 patients prospectively recruited, 46 were diagnosed as having TBM and 22 as non-TBM. We compared the cf-TB method with CSF smear microscopy, mycobacterial culture, and the Xpert MTB/RIF assay (Xpert) using the consensus case definition for TBM proposed in 2009 as a reference standard. The sensitivity of the cf-TB test was 56.5% (26/46) in patients with TBM, and it was significantly higher than other methods: microscopy (2.2%, 1/46; P < .001), mycobacterial culture (13.0%, 6/46; P < .001), and Xpert (23.9%, 11/46; P = .001). For specificity, none of the four methods reported false-positive results in the non-TBM group. The new method detecting cell-free M tuberculosis DNA in CSF is rapid and accurate for diagnosis of TBM and easily incorporated into regular laboratory tests.

Diagnosis of tuberculosis meningitis by using Trc4 and Is6110 primers in Bangladesh

Meningitis caused by Mycobacterium tuberculosis remains an important cause of morbidity and mortality worldwide and presents particular challenges in terms of diagnosis and management The prevalence of TB meningitis remains largely underestimated due to nonspecific clinical manifestation At early stages diagnosis is largely based on microscopy and culture which are often less sensitive and time consuming This study was aimed to evaluate the diagnostic potentials of urinary polymerase chain reaction PCR by using TRC and IS primers Further the results were also compared by culture on Lowenstein Jensen LJ media and AFB smear by Zeihl Nelson ZN staining A total of CSF samples were studied from clinically suspected cases of tubercular meningitis All the samples were processed for conventional ZN staining TB culture on LJ media and TB PCR by IS and TRC primers by standard protocols Of the total samples cases were diagnostically positive TB meningitis samples among which bacteriological test were positive in only cases PCR assay detected MTb in patients by TRC primers and in patients by IS primers Since some strains of MTB may lack the IS element in their genome using TRC primer instead of IS is superior in diagnosing tubercular meningitis by PCR assay

Proteomic profile of pulmonary and extra pulmonary TB samples

Introduction: Tuberculosis (TB) is a major health problem in India, so early diagnosis and treatment of Mycobacterium tuberculosis (M.tb.) infection can prevent deaths from this pathogen. The secretion of proteins by M.tb. is important in diagnostic purposes for generation of therapeutic drugs and vaccines candidates for TB. The objective of this study was to identify the protein expression (biomarkers) in TB and Tuberculosis meningitis (TBM) using proteomic approach.&#x0D; Methods: In this study, using Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDSPAGE), we analyzed the secretory proteins of M.tb. in serum, cerebrospinal fluid (CSF) samples. The identified proteins were determined by Total Lab- 100 Quantity One densitometry software.&#x0D; Results: Our study showed that protein bands expressed in CSF samples reveals the presence of 72kD, 70kD, 44kD, 40kD &amp; 16kD predominantly in TBM patients compared to healthy individuals. The electrophoretogram identified 97kD, 72kD, 44kD, 38kD, 29kD &amp; 16kD predominant proteins in serum samples of TB patients.&#x0D; Conclusion: The detection of secretory proteins in serum and CSF samples of M.tb. in TB and TBM patients gives reliable and early diagnosis of TB and TBM. The secretory proteins can be useful as immunodiagnostic and vaccine targets which can serve as important biomarkers

Tuberculosis meningitis: Early diagnosis and treatment with clinical analysis of 180 patients

ObjectiveTo analyze the clinical, and imaging features of tuberculosis meningitis (TBM) and to improve its diagnostic accuracy. MethodThe clinical data, image features and clinical outcomes of 180 TBM patients from 2011 to 2013 of Shandong Provincial Chest Hospital were analyzed retrospectively. ResultsThe majority of 180 TBM patients were chronic or subacute onset. Extracranial manifestations of TB accounted for 76.7% (138/180) of the cases. Abnormal brain MRI findings were found in 152 TBM patients (152/180, 84.4%), including meningeal thickening and enhancement, tuberculomas, hydrocephalus, and multi-compartment involvement lesions. Three patients died of hydrocephalus. ConclusionsThe presence of extracranial tuberculosis and typical brain MRI findings are important contributing factors in order to make an early diagnosis of TBM. Imaging examination is of great importance for the prognosis of tuberculous meningitis.

Delta-like 1 protein, vitamin D binding protein and fetuin for detection of Mycobacterium tuberculosis meningitis.

Tuberculosis meningitis (TBM) diagnosis is difficult, new biomarkers are needed. We evaluated the diagnostic utility of delta-like 1 protein (DLL1), vitamin D binding protein (VDBP) and fetuin. Biomarker concentrations were measured by ELISA in cryopreserved cerebrospinal fluid from 139 HIV-infected Ugandans with suspected meningitis. TBM was diagnosed by GeneXpert MTB/Rif or culture. Cohort diagnoses included TBM (n=22), cryptococcal (n=71), or aseptic meningitis (n=16) and no meningitis (n=30). DLL1 (cut-off value 1150pg/ml) provided 32% sensitivity and 98% specificity. Adding fetuin, cryptococcal antigen and IFN-γ resulted in sensitivities of 36, 63 and 76% with specificities of 98, 90 and 92%, respectively. VDBP (cut-off value 2.0μg/ml) provided 81% sensitivity and 68% specificity while fetuin (cut-off value 2μg/ml) provided a sensitivity of 86% and specificity of 68%. CSF DLL1, VDBP and fetuin exhibited fair diagnostic performance for TBM diagnosis.

Incidence of tuberculosis meningitis in a high HIV prevalence setting: time-series analysis from 2006 to 2011.

This study was undertaken at a tertiary hospital in Soweto, a peri-urban low-middle income setting. Mycobacterium tuberculosis meningitis (TBM) is a severe manifestation of extra-pulmonary tuberculosis. To describe the incidence, mortality and clinical features of TBM in human immunodeficiency virus (HIV) infected and non-infected children in South Africa from 2006 to 2011. A retrospective, cross-sectional descriptive study. Electronic databases and individual patient records of all children with a discharge diagnosis of TBM were reviewed to yield incidence rate ratios (IRR) in HIV-infected and non-infected children. Clinical, laboratory and radiological characteristics were compared between HIV-infected and non-infected children with TBM. Overall TBM incidence per 100 000 population in 2006 was 6.9 (95%CI 4.4-10.3) and 9.8 (95%CI 6.9-13.6) in 2009, but had subsequently declined to 3.1 (95%CI 1.6-5.5) by 2011. There was a significant reduction in the IRR of TBM among HIV-infected children (IRR 0.916, P = 0.036). The overall case fatality ratio was 6.7%. Clinical features, cerebrospinal fluid and computed tomography brain findings were similar in HIV-infected and non-infected children. TBM incidence decreased over the study period from 2006 to 2011, and was temporally associated with an increase in the uptake of antiretroviral treatment in HIV-infected individuals.

The Relationship between Characteristics of Cerebospinal Fluid and Tuberculous Meningitis detected using Real Time PCR

Introduction: Tuberculosis (TB) carries a high morbidity and mortality, however, its diagnosis can be difficult due to low concentration of bacteria in the cerebrospinal fluid (CSF). Although increased CSF protein, decreased CSF glucose; cerebrospinal fluid (CSF) pleocytosis with mononuclear cells predominance are commonly used to diagnose TB infection, they show inconsistent results.Objectives: To analyze the relationship between several characteristics of the CSF and TB meningitis.Methods: This is an observational research, with a cross sectional design, 27 patients with TB meningitis and or meningoencephalitis with Thwaites diagnostic score = 4 obtained from mecidal records. The definitive diagnosis of TB meningitis was made using the Ziehl Neelsen (ZN) staining and or culture TB, or polymerase chain reaction (PCR) amplification with the target in IS6110, Ziehl-Neelsen staining (ZN) culture method. Characteristics of CSF including increased CSF protein, decreased CSF glucose, cerebrospinal fluid (CSF) pleocytosis with mononuclear cells predominance and the CSF abnormalities were evaluated in the laboratory of molecular microbiology of Medical Faculty, Diponegoro University/dr Kariadi General Hospital, Semarang. The statistical analysis used was prevalent ratio (RP).Results: Over 27 patients, 12 (44.4%) were diagnosed with definite TB meningitis. Statistical analysis showed that prevalence ratio of the increased levels of protein CSF was 3.143 (95% CI: 0.502 to 19.692), decreased glucose levels was 1.750 (95% CI: 0.501 to 6.112), pleocytosis with a predominance of mononuclear cells was 2.5 (CI 95% : 1.238 to 5.048), whereas the CFS abnormality was RP 2.2 (95% CI: 1.087 to 4.454).Conclusion: This study has shown that pleocytosis with mononuclear cells predominance and CFS abnormalities have a positive relationship with definite TB meningitis.

Evaluation of host Hsp(s) as potential biomarkers for the diagnosis of tuberculous meningitis

ObjectivesDiagnosis of tuberculosis meningitis (TBM) remains challenging in tuberculosis (TB) endemic countries. The need for TB biomarkers arises, in part, from the difficulty of accurately diagnosing TBM with the available methods. Patients and methodsTo explore the potential of host Hsps (Hsp 25, Hsp 60, Hsp 70 and Hsp 90) as an alternative marker in TBM diagnosis, we evaluated cerebrospinal fluid (CSF) sample of TBM (n=49), Pyogenic Meningitis (PM) (n=20), Viral Meningitis (VM) (n=09), Fungal Meningitis (FM) (n=04) and non infectious control (n=79) patients using indirect ELISA. ResultsOut of four Hsps, Hsp 70 and Hsp 90 yields 89% & 88% sensitivity and 82% & 89% specificity, respectively. The positive (PPV) and negative (NPV) predictive values yielded in TBM group for Hsp 70 was 86.27% (73.74–94.27) and 93.51% (85.48–97.83), respectively. For Hsp 90 the obtained PPV was 89.36% (76.88–96.41) and NPV was 91.36% (82.99–96.44). In 86% of TBM patients all the four Hsps were found to be positive and none of the patient was found to be negative for all Hsps in the same group. ConclusionsThe data presented in the study indicate that host Hsp 70 and Hsp 90 shows good sensitivity and specificity and have potential in the diagnosis of TBM disease. The combined use of all Hsps (Hsp 25, Hsp 60, Hsp 70 and Hsp 90) effectively distinguishes patients with TBM from other disease controls.

Pulmonary tuberculosis with meningitis

We read with great interest the case report by GoicBarisic et al. [1] on “pulmonary tuberculosis with meningitis in a 7-month-old infant”. The case report provides an excellent overview of the pathogenesis and diagnosis of tuberculosis meningitis. It also rightly emphasizes the importance of screening and introducing chemoprophylaxis in infants exposed to patients with active tuberculosis as well as early discovery and therapy of the illness. We would like to share our views in this regard. Tuberculous meningitis though rare in Croatia, is seen commonly in developing countries like India. Other serious forms of extrapulmonary tuberculosis like spinal tuberculosis, abdominal tuberculosis are also frequently encountered. One of the reasons for this might be the increase in the number of human immunodeficiency virus cases, which causes decreased immunity and dissemination of tuberculosis to different parts of the body. Other factors contributing are overcrowding, delay in diagnosis and inadequate health facilities [2]. As per World Health Organization guidelines for treatment of tuberculous meningitis by Directly Observed Therapy Short Course, isoniazid, rifampin, pyrazinamide and streptomycin are given for 2 months followed by isoniazid and rifampicin for the next 4 months. Countries applying Directly Observed Thera-

258 The Optic Nerve Sheath Diameter in Cerebral Infections

258 The Optic Nerve Sheath Diameter in Cerebral Infections

Primary spinal leptomeningeal gliomatosis in a 3-year-old boy revealed with MRI and FDG PET/CT mimicking tuberculosis meningitis

A 3-year-old boy was referred to neurologist for inward devition of his left eye, weakness, lack of appetite, headache and ehavioral change. On physical examination, the findings of ilateral abducens nerve paralysis were noted. Cranial magnetic esonance imaging (MRI) revealed diffuse leptomeningeal contrast nhancement at the supra-infratentorial regions predominantly nvolving the basal cisterns and also hydrocephalus and initially uggesting basilar meningitis. Cerebrospinal fluid (CSF) studies howed normal glucose and elevated protein levels but no tumor ells. No growth was detected in any of the bacterial cultures ncluding acid-resistant bacteria. The patient was started on oral nti-tuberculosis medication and corticosteroid treatment with he presumed diagnosis of tuberculosis meningitis and a ventricuoperitoneal (VP) shunt was inserted due to hydrocephalus. After months of treatment, the patient was re-admitted to hospial with vomiting, convulsion and confusion. Cranial MRI showed he similar findings to previous one, and spinal MRI depicted iffuse leptomeningeal contrast enhancement as well as microystic changes along the spinal cord (Fig. 1). Histopathology of the ural biopsy material revealed widespread glioma infiltration of he subarachnoid space suggestive of leptomeningeal gliomatosis. his patient with unknown primary was referred for FDG PET/CT. nder child sedation, brain and whole body non-contrast enhanced ET/CT images were obtained 90 min after the intravenous injecion of 148MBq (4mCi) 18F FDG using a Biograph 6 PET/CT. The can depicted slightly increased FDG uptake (SUVmax 2.1)along the pinal cord without any other FDG-avid primary tumor. The patient as started on chemotherapy including vincristine and carboplatin Figs. 2 and 3). His symptoms were relieved after completion of hemo. Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare isease thought to arise from isolated astrocytic cell nests also nown as heterotropic neuroglial tissue within the leptomeninges HLNT) in the subarachnoid space. The HLNT can transform into two

T-cell-based assays on cerebrospinal fluid and PBMCs for rapid diagnosis of TB meningitis in non-HIV patients

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 …

Evaluation of Lionex TB kits and mycobacterial antigens for IgG and IgA detection in cerebrospinal fluid from tuberculosis meningitis patients

To evaluate commercial Lionex TB together with four antigens of Mycobacterium tuberculosis (MPT-64, MT10.3, 16 kDa and 38 kDa) for IgG and IgA cerebrospinal fluid (CSF) detection in the diagnosis of tuberculosis meningitis (TBM) with CSF negative acid-fast bacilli staining, 19 cases of TBM, 64 cases of other infectious meningoencephalitis and 73 cases of other neurological disorders were tested by enzyme linked immunosorbent assay. IgA-MPT-64 and IgG Lionex showed the highest sensitivities, specificities, positive predictive value and negative predictive value (63.2%, 47.4%; 95%, 93.7%; 40%, 98% and 28.4%, 97.1%, respectively). However, while grey zone was 12.7% and 6%, respectively, lowering sensitivity but maintains high specificity (>or= 95%). High protein concentration in CSF was associated with antibody positivity CSF/HIV+ which did not influence the sensitivity of both tests. To our knowledge, this is the first description of IgA-MPT-64 and IgG Lionex antibodies in CSF-TBM and, although there is good specificity, adjustments are needed based on antigen composition to enhance sensitivity.

To compare CSF adenosine deaminase levels and CSF-PCR for tuberculous meningitis

This study was planned to compare the adenosine deaminase (ADA) levels and polymerase chain reaction (PCR) in cerebrospinal fluid (CSF) as a rapid method to diagnose tuberculosis meningitis (TBM). Fifty-four adult patients with suspected TBM and 37 controls were included in this study. The median ADA level was 21 U/L of most likely TBM, 14 U/L of unconfirmed TBM and 5 U/L of controls. PCR for Mycobacterium tuberculosis was positive in 12 out of 27 most likely TBM cases, 5 out of 27 unconfirmed TBM cases and 3 out of 37 controls. Using a cut off level of >10 U/L, CSF-ADA had a sensitivity of 92.5% and specificity of 97% for the diagnosis of TBM. PCR for M. tuberculosis had a sensitivity of 44.5% and specificity 92% in the most likely TBM cases. This study shows that CSF-ADA is a more sensitive indicator than PCR for the diagnosis of M. tuberculosis.