title: Antibody detection tests for early diagnosis in tuberculous meningitis.
abstract: BACKGROUND
  Tuberculous meningitis (TBM) is the most severe form of tuberculosis. Microbiological confirmation is rare and treatment is often delayed. Early diagnosis and immediate initiation of treatment are essential for effective TBM control. A systematic review was performed in this study to assess the diagnostic accuracy of detecting antibodies against Mycobacterium tuberculosis in the cerebrospinal fluid (CSF), according to standard methods. Test performance was summarized using a bivariate random-effects meta-analysis.
  
  
  METHODS
  Studies were identified by a search of the literature, up to July 25, 2015, in the EMBASE and MEDLINE databases via Ovid SP and PubMed. The Cochrane Library was also searched for original, peer-reviewed molecular epidemiology studies that reported the diagnosis of TBM based on antibody detection in the CSF.
  
  
  RESULTS
  Thirty-six articles (58 studies) were identified. The sensitivity of antibody detection was 0.75 (95% confidence interval (CI) 0.66-0.82), specificity was 0.98 (95% CI 0.96-0.99), and the area under the receiver operating characteristic curve (AUROC) was 0.97 (95% CI 0.95-0.98). By subgroup analysis, the detection of anti-M37Ra was the highest (AUROC 0.99, 95% CI 0.98-1.00), followed by anti-antigen 5 (AUROC 0.99, 95% CI 0.97-0.99) and anti-M37Rv (AUROC 0.97, 95% CI 0.95-0.98).
  
  
  CONCLUSIONS
  For the early diagnosis of TBM based on antibodies in the CSF, the detection of anti-M37Ra, anti-antigen 5, or anti-M37Rv provides the greatest sensitivity and specificity.
authors.affiliation: Department of Laboratory Medicine, the First Affiliated Hospital of Shantou University Medical College, Chang Ping Road, 57, Shantou, Guangdong 515041, China.
authors.forename: T Y
authors.initials: TY
authors.lastname: Huang
authors.affiliation: Department of Laboratory Medicine, the First Affiliated Hospital of Shantou University Medical College, Chang Ping Road, 57, Shantou, Guangdong 515041, China.
authors.forename: X X
authors.initials: XX
authors.lastname: Zhang
authors.affiliation: Guangdong Key Laboratory of Medical Molecular Imaging, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Q L
authors.initials: QL
authors.lastname: Wu
authors.affiliation: Department of Thoracic Medicine, The Third People's Hospital of Shantou City, Guangdong, China.
authors.forename: W G
authors.initials: WG
authors.lastname: Peng
authors.affiliation: Guangdong Key Laboratory of Medical Molecular Imaging, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: G L
authors.initials: GL
authors.lastname: Zheng
authors.affiliation: Department of Laboratory Medicine, the First Affiliated Hospital of Shantou University Medical College, Chang Ping Road, 57, Shantou, Guangdong 515041, China.
authors.forename: Y M
authors.initials: YM
authors.lastname: Cai
authors.affiliation: Department of Laboratory Medicine, the First Affiliated Hospital of Shantou University Medical College, Chang Ping Road, 57, Shantou, Guangdong 515041, China.
authors.forename: M C
authors.initials: MC
authors.lastname: Pang
authors.affiliation: Department of Laboratory Medicine, the First Affiliated Hospital of Shantou University Medical College, Chang Ping Road, 57, Shantou, Guangdong 515041, China. Electronic address: yinge_wu@126.com.
authors.forename: Y E
authors.initials: YE
authors.lastname: Wu
mesh_terms: D000907:Antibodies, Bacterial / Q000134:cerebrospinal fluid*; D042241:Early Diagnosis; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000276:immunology*; D012372:ROC Curve; D014390:Tuberculosis, Meningeal / Q000175:diagnosis*
chemical_list: D000907:Antibodies, Bacterial
keywords: Antibody detection tests; Cerebrospinal fluid; Diagnosis; Tuberculous meningitis