Diagnostic usefulness of T-cell based assays for tuberculous meningitis in HIV-uninfected patients

Summary Objectives Early diagnosis and treatment of tuberculous meningitis (TBM) is essential for a positive outcome, but sensitive, specific, and rapid diagnostic tests for TBM are lacking. We evaluated the diagnostic utility of enzyme-linked immunosorbent spot (ELISPOT) assays in HIV-uninfected pa...

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Bibliographic Details
Published in:The Journal of infection 2016-04, Vol.72 (4), p.486-497
Main Authors: Park, Ki-Ho, Lee, Mi Suk, Kim, Sun-Mi, Park, Su-Jin, Chong, Yong Pil, Lee, Sang-Oh, Choi, Sang-Ho, Kim, Yang Soo, Woo, Jun Hee, Kang, Joong Koo, Lee, Sang-Ahm, Kim, Sung-Han
Format: Article
Language:English
Subjects:
Adult
Algorithms
Cerebrospinal fluid
Cerebrospinal Fluid - cytology
Diagnosis
Enzyme-Linked Immunospot Assay
Female
Human immunodeficiency virus
Humans
Infectious Disease
Male
Meningitis
Middle Aged
Mycobacterium tuberculosis
Prospective Studies
Republic of Korea
T-Lymphocytes - cytology
T-Lymphocytes - immunology
Tuberculosis
Tuberculosis, Meningeal - cerebrospinal fluid
Tuberculosis, Meningeal - diagnosis
Tuberculosis, Meningeal - immunology
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Summary:Summary Objectives Early diagnosis and treatment of tuberculous meningitis (TBM) is essential for a positive outcome, but sensitive, specific, and rapid diagnostic tests for TBM are lacking. We evaluated the diagnostic utility of enzyme-linked immunosorbent spot (ELISPOT) assays in HIV-uninfected patients with suspected TBM. Methods All HIV-uninfected patients with suspected TBM were prospectively enrolled at a tertiary care hospital in an intermediate TB-burden country, during a 6-year period. ELISPOT assays were performed on peripheral blood mononuclear cells (PBMC) and cerebrospinal fluid-mononuclear cells (CSF-MC). Results Of the 276 evaluable patients, 90 (33%) were classified as having TBM (30 definite cases, 19 probable, and 41 possible), and 186 (67%) as having non-TBM. When comparing definite TBM versus non-TBM, the sensitivity and specificity of the PBMC ELISPOT assay (≥6 spots; manufacturer's recommended cut-off) for diagnosing TBM were 96% (95% CI, 82–100) and 58% (95% CI, 50–66), respectively. The CSF-MC ELISPOT assay (≥38 spots; receiver operating characteristic [ROC]-derived cut-off) was a useful rule-in test with specificity of 95% (96% CI, 90–98). Its sensitivity was 68% (95% CI, 45–86), which was superior those of AFB smear microscopy (14%; P  
ISSN:0163-4453
1532-2742
DOI:10.1016/j.jinf.2016.01.012