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Sub acute and chronic meningitis in children--an immunological study of cerebrospinal fluid
1Department of Medical Microbiology, National Institute of Mental Health and Neuro Sciences, Bangalore.
Abstract:
Cerebrospinal fluid (CSF) from 274 cases of subacute to chronic meningitis in age groups from 3 months to 12 years were analysed for the presence of antibody response to mycobacterial and cysticercal antigens by enzyme linked immunosorbent assay (ELISA). Simultaneously other correlative parameters such as CSF cell cytology by cytospin studies, mycobacterial antigens of Lipoarabinomannan (LAM) type (a polysaccharide antigen) by reverse passive haemagglutination assay (RPHA) CSF C-reactive protein (CRP) by latex agglutination and microbial cultures for mycobacterium tuberculosis and fungi were carried out. Antimycobacterial antibody was present in 35.4% of the cases. In 57.66% of the cases there was no demonstrable immune response to either mycobacterial or cysticercal antigens. However, it was interesting to note that 5.47% of the cases revealed the presence of anticysticercal antibody in the CSF. The mycobacterial antigen (LAM polysaccharide antigen) was found in 72.6% of the cases. There was no evidence of carcinomatous or cryptococcal meningitis. This study stresses the role of multimodal diagnostic tests on CSF for investigating cases of chronic and subacute meningitis irrespective of leading clues such as tuberculosis.
Insights
This study investigated cerebrospinal fluid (CSF) in pediatric meningitis, finding mycobacterial antigen in 72.6% of cases. Multimodal diagnostic tests are crucial for diagnosing chronic meningitis in children.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Immunology
Background:
- Subacute and chronic meningitis in children present diagnostic challenges.
- Cerebrospinal fluid (CSF) analysis is key for identifying causative agents.
- Previous studies have focused on specific pathogens, potentially overlooking others.
Purpose of the Study:
- To evaluate the utility of multimodal diagnostic tests in pediatric subacute to chronic meningitis.
- To assess the prevalence of immune responses to mycobacterial and cysticercal antigens in CSF.
- To determine the presence of mycobacterial antigens (LAM) and other inflammatory markers in pediatric meningitis cases.
Main Methods:
- Enzyme-linked immunosorbent assay (ELISA) for antibody detection against mycobacterial and cysticercal antigens in CSF.
- Cytospin studies for CSF cell cytology.
- Reverse passive haemagglutination assay (RPHA) for Lipoarabinomannan (LAM) antigen detection.
- Latex agglutination for C-reactive protein (CRP) and microbial cultures for Mycobacterium tuberculosis and fungi.
Main Results:
- Antimycobacterial antibodies were detected in 35.4% of cases.
- Anticysticercal antibodies were found in 5.47% of cases.
- Mycobacterial antigen (LAM) was present in 72.6% of cases, while 57.66% showed no immune response to tested antigens.
- No evidence of carcinomatous or cryptococcal meningitis was found.
Conclusions:
- Multimodal diagnostic testing of CSF is essential for investigating pediatric subacute and chronic meningitis.
- The presence of mycobacterial antigen (LAM) is common, irrespective of specific clinical clues.
- Comprehensive CSF analysis aids in accurate diagnosis and management of pediatric meningitis.