Rapid diagnosis of Mycobacterium tuberculosis meningitis by enumeration of cerebrospinal fluid antigen-specific T-cells.
METHODS
Hospital in-patients with suspected tuberculous meningitis (TBM), predominantly in India.


OBJECTIVE
To determine whether interferon-gamma (IFN-gamma) secreting Mycobacterium tuberculosis antigen-specific T-cells are present in the cerebrospinal fluid (CSF) of patients with TBM and to evaluate the feasibility of CSF enzyme-linked immunospot (ELISpot) for the diagnosis of active TBM.


METHODS
Prospective blinded hospital-based study.


RESULTS
The overnight ELISpot assay detected M. tuberculosis antigen-specific IFN-gamma secreting T-cells in CSF from nine of 10 prospectively recruited patients with TBM, and zero of seven control patients with meningitis of other aetiology. This corresponds to a diagnostic sensitivity of 90% (95%CI 56-100) and specificity of 100% (95%CI 59-100).


CONCLUSIONS
This pilot study demonstrates proof-of-principle for a new T-cell-based diagnostic test for TBM which is rapid, sensitive and specific.
Thomas
M M
MM
Department of Neurology, Christian Medical College, Vellore, India.
Hinks
T S C
TS
Raghuraman
S
S
Ramalingam
N
N
Ernst
M
M
Nau
R
R
Lange
C
C
Kösters
K
K
Gnanamuthu
C
C
John
G T
GT
Marshall
B
B
Lalvani
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000942:Antigens, Bacterial; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D037182:T-Cell Antigen Receptor Specificity; D014390:Tuberculosis, Meningeal / Q000175:diagnosis*
D000942:Antigens, Bacterial; D007371:Interferon-gamma