Diagnostic Value of the Leukocyte Esterase Test for Early Detection of Pleocytosis in Cerebrospinal Fluid of Patients with Suspected Acute Bacterial Meningitis.
BACKGROUND
Rapid and accurate diagnosis of patients with suspected bacterial meningitis (BM) is crucial to prevent potential subsequent mortality and morbidity. The aim of this study was to explore the diagnostic value of the rapid leukocyte esterase (LE) strip test in identifying pleocytosis in cerebrospinal fluid (CSF) samples of patients with suspected BM.


METHODS
A total of 126 patients with suspected meningitis were enrolled in this prospective study. Microscopic examination (cell count and differential) and leukocyte esterase (LE) rapid strip test were performed on cerebrospinal fluid (CSF) samples. Sensitivity, specificity, positive predictive value and negative predictive value of the LE test were determined.


RESULTS
Fifty-two patients (41%) had pleocytosis in the CSF, while 48 (38%) patients had a positive rapid LE strip test result. The diagnostic accuracy of this test for pleocytosis was translated to a sensitivity of 84.6% (95%CI 71.9, 93.1) and a specificity of 94.5% (95%CI 86.7, 98.5), with an area under the receiver operating curve of 0.88.


CONCLUSIONS
The LE strip test, through rapid and accurate determination of CSF pleocytosis, could be considered as an additional test in the diagnosis of bacterial meningitis. It can be tested at bedside and is feasible to do in resource-limited settings.
Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Shervin
S
Shokouhi
Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mehdi
M
Karamipour
Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ilad Alavi
IA
Darazam
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Nariman
N
Sepehrvand
Clinical Research Development Center of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Hasanali
H
Ahmadi
Institute of Human Virology, University of Maryland School of Medicine, Baltimore, United States.
Mohammad M
MM
Sajadi
D000208:Acute Disease; D000368:Aged; D002265:Carboxylic Ester Hydrolases / Q000134:cerebrospinal fluid*; D000068598:Data Accuracy; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007962:Leukocytes / Q000201:enzymology*; D007964:Leukocytosis / Q000175:diagnosis*; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D008875:Middle Aged; D000067716:Point-of-Care Testing; D011446:Prospective Studies; D012372:ROC Curve; D011933:Reagent Kits, Diagnostic / Q000191:economics / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity
D011933:Reagent Kits, Diagnostic; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases
CSF pleocytosis; Meningitis; leukocyte esterase; pleocytosis; rapid strip test