Diagnosis of tuberculous meningitis by detection of antigen and antibodies in CSF and sera.
OBJECTIVE
To evaluate diagnostic potential of three immunological tests, namely, detection of H37Rv antigen of M. Tuberculosis in CSF, detection of antibodies (IgG) against H37Rv in CSF and detection of antibodies (IgG) against H37Rv in serum for diagnosis of tuberculous meningitis in children.


METHODS
50 children diagnosed as patients of tuberculous meningitis were included as cases and 48 children with CNS diseases of nontubercular etiology [pyogenic meningitis (n = 31), encephalitis (n = 10), seizure disorder of unknown etiology (n = 5), brain tumor (n = 2)] served as controls.


METHODS
H37Rv antigen of M. tuberculosis was detected in CSF by Dot ELISA, and antibodies (IgG) against H37Rv in CSF and serum were detected by Plate ELISA.


RESULTS
Detection of H37Rv antigen in CSF was the most sensitive (90%) and specific (95.83%) with positive and negative predictive values of 95.74% and 90.19%, respectively, followed by detection of antibodies in CSF (sensitivity-74%, specificity-89.58%, positive predictive value-88.10%, negative predictive value-76.78%). Detection of antibodies in serum had low sensitivity (50%), specificity (91.67%), positive predictive value (86.21%) and negative predictive value (63.76%).


CONCLUSIONS
Detection of antigen in CSF is a rapid, sensitive and specific test for diagnosis of tuberculous meningitis in children. Detection of antibody in CSF may be useful in some cases but needs further evaluation. Detection of antibody in serum does not appear to be useful for diagnosis of tuberculous meningitis.
Srivastava
K L
KL
Department of Pediatrics, King George's Medical College, Lucknow, India.
Bansal
M
M
Gupta
S
S
Srivastava
R
R
Kapoor
R K
RK
Wakhlu
I
I
Srivastava
B S
BS
D000942:Antigens, Bacterial / Q000097:blood* / Q000134:cerebrospinal fluid*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood* / Q000134:cerebrospinal fluid*; D007223:Infant; D008297:Male; D009169:Mycobacterium tuberculosis / Q000276:immunology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014390:Tuberculosis, Meningeal / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000382:microbiology
D000942:Antigens, Bacterial; D007074:Immunoglobulin G