Rapid diagnosis of Mycobacterium tuberculosis meningitis by enumeration of cerebrospinal fluid antigen-specific T-cells

Thomas, M.M., Hinks, T.S.C., Raghuraman, S., Ramalingam, N., Ernst, M., Nau, R., Lange, C., Kösters, K., Gnanamuthu, C., John, G.T., Marshall, B. and Lalvani, A. (2008) Rapid diagnosis of Mycobacterium tuberculosis meningitis by enumeration of cerebrospinal fluid antigen-specific T-cells. International Journal of Tuberculosis and Lung Disease, 12 (6), 651-657. (PMID:18492332)

Abstract

SETTING: Hospital in-patients with suspected tuberculous meningitis (TBM), predominantly in India.

OBJECTIVE: To determine whether interferon-gamma (IFN-?) secreting Mycobacterium tuberculosis antigen-specific T-cells are present in the cerebrospinal fluid (CSF) of patients with TBM and to evaluate the feasibility of CSF enzyme-linked immunospot (ELISpot) for the diagnosis of active TBM.

DESIGN: Prospective blinded hospital-based study.

RESULTS: The overnight ELISpot assay detected M. tuberculosis antigen-specific IFN-? secreting T-cells in CSF from nine of 10 prospectively recruited patients with TBM, and zero of seven control patients with meningitis of other aetiology. This corresponds to a diagnostic sensitivity of 90% (95%CI 56-100) and specificity of 100% (95%CI 59-100).

CONCLUSION: This pilot study demonstrates proof-of-principle for a new T-cell-based diagnostic test for TBM which is rapid, sensitive and specific.

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