Diagnostic Value of T-Cell Interferon-γ Release Assays on Cerebrospinal Fluid for Tuberculous Meningitis

PLoS One. 2015 Nov 6;10(11):e0141814. doi: 10.1371/journal.pone.0141814. eCollection 2015.

Abstract

Diagnosis of tuberculous meningitis (TBM) remains a challenge. This study aimed to evaluate the performance of T-SPOT.TB test on cerebrospinal fluid mononuclear cells (CSFMCs) for suspected TBM patients. 43 consecutive patients with suspected TBM were enrolled in the study from June 2011 to September 2014. T-SPOT.TB was performed on both CSFMCs and peripheral blood mononuclear cells (PBMCs). The final diagnosis of TBM was independent of the T-SPOT.TB result. The diagnostic sensitivity, specificity, predictive value, and likelihood ratio of T-SPOT.TB on CSFMCs and PBMCs were analyzed. Of the 43 patients, 12 (27.9%) were finally diagnosed with TBM, 28 (65.1%) with non-TBM, and 3 (7.0%) with indeterminate diagnoses. Of 40 cases with definite diagnoses, the sensitivity and specificity were 92.0% and 96.0% for T-SPOT.TB on CSFMCs, and 83.0% and 82.0% for T-SPOT.TB on PBMCs, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of T-SPOT.TB on CSFMCs were 85.0% and 96.0%, respectively. The PPV and NPV were 67.0% and 92.0% for T-SPOT.TB on PBMCs. The difference of T-SPOT.TB between CSFMCs and PBMCs was not significant so far as sensitivity, specificity, PPV, and NPV were concerned (P>0.05 for each). However, T-SPOT.TB on CSFMC and

Csfmc: PBMC in TBM cases seemed higher than that in non-TBM cases. Our study further showed that T-SPOT.TB on CSFMCs might be a rapid and accurate diagnostic test for TBM.

Csfmc: PBMC T-SPOT.TB ratio might be useful for the early diagnosis of TBM.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antigens, Bacterial / immunology
  • Female
  • Hospitals
  • Humans
  • Interferon-gamma Release Tests*
  • Male
  • Middle Aged
  • Sensitivity and Specificity
  • T-Lymphocytes / immunology*
  • T-Lymphocytes / metabolism*
  • Tuberculosis, Meningeal / cerebrospinal fluid*
  • Tuberculosis, Meningeal / diagnosis*
  • Tuberculosis, Meningeal / immunology
  • Young Adult

Substances

  • Antigens, Bacterial

Grants and funding

This study was supported by grants from the National Major Science and Technology Research Projects for the Control and Prevention of Major Infectious Diseases of China (2014ZX10003003; http://www.nmp.gov.cn/zxjs/crb/201012/t20101208_2127.htm), and the Health Research & Special Projects (201402001). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.