- 作者：Lely Solari ; Alonso Soto ; Juan Carlos Agapito ; Vilma Acurio ; Dante Vargas ; Tulia Battaglioli ; Roberto Alfonso Accinelli ; Eduardo Gotuzzo ; Patrick van der Stuyft
- 关键词：Tuberculous meningitis ; Adenosine deaminase ; Sensitivity and specificity ; Diagnosis ; Neurological
- 刊名：International Journal of Infectious Diseases
- 出版年：December, 2013
- 年：2013
- 卷：17
- 期：12
- 页码：e1111-e1115
- 全文大小：358 K
Summary
Objectives
To assess the diagnostic validity of laboratory cerebrospinal fluid (CSF) parameters for discriminating between tuberculous meningitis (TBM) and other causes of meningeal syndrome in high tuberculosis incidence settings.Methods
From November 2009 to November 2011, we included patients with a clinical suspicion of meningitis attending two hospitals in Lima, Peru. Using a composite reference standard, we classified them as definite TBM, probable TBM, and non-TBM cases. We assessed the validity of four CSF parameters, in isolation and in different combinations, for diagnosing TBM: adenosine deaminase activity (ADA), protein level, glucose level, and lymphocytic pleocytosis.
Results
One hundred and fifty-seven patients were included; 59 had a final diagnosis of TBM (18 confirmed and 41 probable). ADA was the best performing parameter. It attained a specificity of 95%, a positive likelihood ratio of 10.7, and an area under the receiver operating characteristics curve of 82.1%, but had a low sensitivity (55%). None of the combinations of CSF parameters achieved a fair performance for 鈥榬uling out鈥?TBM.
Conclusions
Finding CSF ADA greater than 6 U/l in patients with a meningeal syndrome strongly supports a diagnosis of TBM and permits the commencement of anti-tuberculous treatment.