title: Immunological diagnosis as an adjunctive tool for an early diagnosis of tuberculous meningitis of an immune competent child in a low tuberculosis endemic country: a case report.
abstract: BACKGROUND
  Pediatric tuberculous meningitis is a highly morbid, often fatal disease. Its prompt diagnosis and treatment saves lives, in fact delays in the initiation of therapy have been associated with high mortality rates.
  
  
  METHODS
  This is a case of an Italian child who was diagnosed with tuberculous meningitis after a history of a month of headache, fatigue and weight loss. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis with predominance and decreased glucose concentration. Microscopy and conventional diagnostic tests to identify Mycobacterium tuberculosis were negative, while a non classical method based on intracellular cytokine flow cytometry response of CD4 cells in cerebral spinal fluid helped us to address the diagnosis, that was subsequently confirmed by a nested polymerase chain reaction amplifying a 123 base pair fragment of the M. tuberculosis DNA.
  
  
  CONCLUSIONS
  We diagnosed tuberculous meningitis at an early stage through an innovative immunological approach, supported by a nested polymerase chain reaction for detection of M. tuberculosis DNA. An early diagnosis is required in order to promptly initiate a therapy and to increase the patient's survival.
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University, 00185, Rome, Italy. serena.vita@uniroma1.it.
authors.forename: Serena
authors.initials: S
authors.lastname: Vita
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University, 00185, Rome, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Ajassa
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University, 00185, Rome, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Caraffa
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University, Polo Pontino, 04100, Latina, Italy.
authors.forename: Miriam
authors.initials: M
authors.lastname: Lichtner
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University, 00185, Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Mascia
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University, 00185, Rome, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Mengoni
authors.affiliation: Microbiology Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani, 00149, Rome, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Paglia
authors.affiliation: Department of Neurology and Psychiatry, Division of Neurosurgery, Sapienza, 00185, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mancarella
authors.affiliation: Department of Neurology and Psychiatry, Division of Neurosurgery, Sapienza, 00185, Rome, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Colistra
authors.affiliation: Department of Emergency and Acceptance, Unit of Radiology, Policlinico Umberto I, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Di Biasi
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University, 00185, Rome, Italy.
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Ciardi
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University, Polo Pontino, 04100, Latina, Italy.
authors.forename: Claudio Maria
authors.initials: CM
authors.lastname: Mastroianni
authors.affiliation: Department of Public Health and Infectious Diseases, Sapienza University, 00185, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Vullo
mesh_terms: D002648:Child; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007964:Leukocytosis; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology
keywords: Children; Hydrocephalus; ICCFC; Immunological diagnosis; Tuberculous meningitis