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. 1986 May;61(5):428–435. doi: 10.1136/adc.61.5.428

Evaluation of adenosine deaminase activity and antibody to Mycobacterium tuberculosis antigen 5 in cerebrospinal fluid and the radioactive bromide partition test for the early diagnosis of tuberculosis meningitis.

Y M Coovadia, A Dawood, M E Ellis, H M Coovadia, T M Daniel
PMCID: PMC1777799  PMID: 3087296

Abstract

A number of different biochemical and serological tests have been described recently for the early and accurate diagnosis of tuberculous meningitis. None of these tests has yet gained widespread acceptance in clinical medicine or in microbiology laboratories. To investigate this problem we evaluated adenosine deaminase activity (ADA), an enzyme linked immunosorbent assay (ELISA) that detects antibody to antigen 5 of Mycobacterium tuberculosis, and the radioactive bromide partition test (BPT) in the cerebrospinal fluid (CSF). Cerebrospinal fluid specimens from children with tuberculous, pyogenic, and viral meningitis as well as from patients with pulmonary tuberculosis without meningitis and from controls with normal CSFs were included inn the study. In addition, we estimated ADAs in serum samples from selected children in these groups. The sensitivity and specificity of the three tests evaluated in the CSF were: ADA assay 73% and 71%; BPT 92% and 92%; and ELISA for antibody to antigen 5, 53% and 90%, 40% and 94%, and 27% and 100%, respectively, at tires of more than or equal to 1:20, 1:40, and 1:80. The serum ADA was lower (11.0 +/- 6.15 IU/l) in children with tuberculous meningitis when compared with those with pulmonary tuberculosis alone (25.8 +/- 20.9 IU/l). The BPT was found to be the most reliable test in the early differentiation of tuberculous from other causes of meningitis and remained abnormal for a period of up to five months after the beginning of treatment. Accordingly, we believe that the BPT should be used in conjunction with bacterial and fungal antigen detection systems for the initial differentiation of clinically suspicious tuberculous meningitis from Gram or culture negative cases, or both, of bacterial and fungal meningitis.

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Selected References

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  1. Benjamin R. G., Daniel T. M. Serodiagnosis of tuberculosis using the enzyme-linked immunoabsorbent assay (ELISA) of antibody to Mycobacterium tuberculosis antigen 5. Am Rev Respir Dis. 1982 Dec;126(6):1013–1016. doi: 10.1164/arrd.1982.126.6.1013. [DOI] [PubMed] [Google Scholar]
  2. Blake J., Berman P. The use of adenosine deaminase assays in the diagnosis of tuberculosis. S Afr Med J. 1982 Jul 3;62(1):19–21. [PubMed] [Google Scholar]
  3. CROOK A., DUNCAN H., GUTTERIDGE B., PALLIS C. Use of 82Br in differential diagnosis of lymphocytic meningitis. Br Med J. 1960 Mar 5;1(5174):704–706. doi: 10.1136/bmj.1.5174.704. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Craven R. B., Brooks J. B., Edman D. C., Converse J. D., Greenlee J., Schlossberg D., Furlow T., Gwaltney J. M., Jr, Miner W. F. Rapid diagnosis of lymphocytic meningitis by frequency-pulsed electron capture gas-liquid chromatography: differentiation of tuberculous, cryptococcal, and viral meningitis. J Clin Microbiol. 1977 Jul;6(1):27–32. doi: 10.1128/jcm.6.1.27-32.1977. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Hernández R., Muñoz O., Guiscafre H. Sensitive enzyme immunoassay for early diagnosis of tuberculous meningitis. J Clin Microbiol. 1984 Sep;20(3):533–535. doi: 10.1128/jcm.20.3.533-535.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Idriss Z. H., Sinno A. A., Kronfol N. M. Tuberculous meningitis in childhood. Forty-three cases. Am J Dis Child. 1976 Apr;130(4):364–367. doi: 10.1001/archpedi.1976.02120050022004. [DOI] [PubMed] [Google Scholar]
  7. Kalish S. B., Radin R. C., Levitz D., Zeiss C. R., Phair J. P. The enzyme-linked immunosorbent assay method for IgG antibody to purified protein derivative in cerebrospinal fluid of patients with tuberculous meningitis. Ann Intern Med. 1983 Nov;99(5):630–633. doi: 10.7326/0003-4819-99-5-630. [DOI] [PubMed] [Google Scholar]
  8. Kocen R. S. Meningitis. Tuberculous meningitis. Br J Hosp Med. 1977 Nov;18(5):436, 440-1, 443-4 passim. [PubMed] [Google Scholar]
  9. Krambovitis E., McIllmurray M. B., Lock P. E., Hendrickse W., Holzel H. Rapid diagnosis of tuberculous meningitis by latex particle agglutination. Lancet. 1984 Dec 1;2(8414):1229–1231. doi: 10.1016/s0140-6736(84)92792-2. [DOI] [PubMed] [Google Scholar]
  10. Malan C., Donald P. R., Golden M., Taljaard J. J. Adenosine deaminase levels in cerebrospinal fluid in the diagnosis of tuberculous meningitis. J Trop Med Hyg. 1984 Feb;87(1):33–40. [PubMed] [Google Scholar]
  11. Mann M. D., Macfarlane C. M., Verburg C. J., Wiggelinkhuizen J. The bromide partition test and CSF adenosine deaminase activity in the diagnosis of tuberculosis meningitis in children. S Afr Med J. 1982 Sep 18;62(13):431–433. [PubMed] [Google Scholar]
  12. Mårdh P. A., Larsson L., Høiby N., Engbaek H. C., Odham G. Tuberculostearic acid as a diagnostic marker in tuberculous meningitis. Lancet. 1983 Feb 12;1(8320):367–367. doi: 10.1016/s0140-6736(83)91676-8. [DOI] [PubMed] [Google Scholar]
  13. Roberts F. J. Problems in the diagnosis of tuberculous meningitis. Arch Neurol. 1981 May;38(5):319–320. doi: 10.1001/archneur.1981.00510050085018. [DOI] [PubMed] [Google Scholar]
  14. Sada E., Ruiz-Palacios G. M., López-Vidal Y., Ponce de León S. Detection of mycobacterial antigens in cerebrospinal fluid of patients with tuberculous meningitis by enzyme-linked immunosorbent assay. Lancet. 1983 Sep 17;2(8351):651–652. doi: 10.1016/s0140-6736(83)92532-1. [DOI] [PubMed] [Google Scholar]
  15. Sumaya C. V., Simek M., Smith M. H., Seidemann M. F., Ferriss G. S., Rubin W. Tuberculous meningitis in children during the isoniazid era. J Pediatr. 1975 Jul;87(1):43–49. doi: 10.1016/s0022-3476(75)80066-7. [DOI] [PubMed] [Google Scholar]
  16. TAYLOR L. M., SMITH H. V., HUNTER G. The blood-C.S.F. barrier to bromide in diagnosis of tuberculous meningitis. Lancet. 1954 Apr 3;266(6814):700–702. doi: 10.1016/s0140-6736(54)92108-x. [DOI] [PubMed] [Google Scholar]
  17. Wiggelinkhuizen J., Mann M. The radioactive bromide partition test in the diagnosis of tuberculous meningitis in children. J Pediatr. 1980 Nov;97(5):843–847. doi: 10.1016/s0022-3476(80)80286-1. [DOI] [PubMed] [Google Scholar]

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