title: Comparison of gel-based methods for the detection of cerebrospinal fluid rhinorrhea.
abstract: Cerebrospinal fluid (CSF) rhinorrhea is a serious condition that may result in severe complications. Various laboratory tests, relying on the detection of CSF-specific proteins in nasal secretions, have been developed but diagnosis remains challenging. The aim of this study was to evaluate two new methods targeting either ß2-transferrin or beta-trace-protein. Rhinorrhea samples from patients suspected of CSF leakage (n=36) were analyzed using two-dimensional gel electrophoresis (2-DE) for CSF rhinorrhea diagnosis. Twelve patients with rhinorrhea strongly suggestive of a CSF leak also underwent a fluorescein test. The same cohort was retrospectively analyzed with a beta-trace protein immunoblot developed in-house (n=36) and a new commercial ß2-transferrin immunofixation assay (Sebia, Evry, France) (n=33). 2-DE was positive in 9 patients suffering from rhinorrhea following skull base fracture (n=3), post-surgery (n=4), or spontaneously (n=2). The 27 remaining cases were negative. These results were confirmed by the beta-trace protein immunoblot and ß2-transferrin immunofixation tests, except for one sample found negative with 2-DE but positive with the two other assays. Results from the three analytical methods were concordant with fluorescein tests. Beta-trace protein immunoblot and ß2-transferrin immunofixation assays are fast and reliable methods that allow detecting CSF leakage in nasal fluid with high sensitivity and specificity.
authors.affiliation: Division of Laboratory Medicine, Department of Genetic and Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland. pierre.lescuyer@hcuge.ch
authors.forename: Pierre
authors.initials: P
authors.lastname: Lescuyer
authors.forename: Lucas
authors.initials: L
authors.lastname: Auer
authors.forename: Véronique
authors.initials: V
authors.lastname: Converset
authors.forename: Denis F
authors.initials: DF
authors.lastname: Hochstrasser
authors.forename: Basile N
authors.initials: BN
authors.lastname: Landis
authors.forename: Pierre R
authors.initials: PR
authors.lastname: Burkhard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis*; D005260:Female; D006801:Humans; D015151:Immunoblotting / Q000379:methods*; D007122:Immunoelectrophoresis / Q000379:methods*; D019746:Intramolecular Oxidoreductases / Q000032:analysis; D054834:Lipocalins / Q000032:analysis; D008297:Male; D008875:Middle Aged; D014168:Transferrin / Q000032:analysis; D055815:Young Adult
chemical_list: D054834:Lipocalins; D014168:Transferrin; D019746:Intramolecular Oxidoreductases; C022466:prostaglandin R2 D-isomerase