title: Diagnosis of tuberculous meningitis by detection of antigen and antibodies in CSF and sera.
abstract: 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.
authors.affiliation: Department of Pediatrics, King George's Medical College, Lucknow, India.
authors.forename: K L
authors.initials: KL
authors.lastname: Srivastava
authors.forename: M
authors.initials: M
authors.lastname: Bansal
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.forename: R
authors.initials: R
authors.lastname: Srivastava
authors.forename: R K
authors.initials: RK
authors.lastname: Kapoor
authors.forename: I
authors.initials: I
authors.lastname: Wakhlu
authors.forename: B S
authors.initials: BS
authors.lastname: Srivastava
mesh_terms: 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
chemical_list: D000942:Antigens, Bacterial; D007074:Immunoglobulin G