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Cerebrospinal fluid adenosine deaminase activity and C-reactive protein in tuberculous and partially treated
1Department of Pediatrics, Banaras Hindu University, Varanasi.
Abstract:
Adenosine deaminase (ADA) activity measurement and C-reactive protein (C-RP) detection were done in CSF of 27 tuberculous meningitis (TBM) and 8 patients of partially treated bacterial meningitis, apart from routine biochemical tests. Both the groups had comparable CSF cell count, protein and sugar concentrations. The mean CSF ADA activity was significantly raised in TBM as compared to partially treated bacterial meningitis patients (p < 0.05). A cut-off ADA level < or = 5 IU/L and C-RP positively were used for differentiation of partially treated bacterial from TBM cases. Based on this, the sensitivity and specificity of ADA and C-RP were 62.5%, 88.9% and 75%, 100%, respectively. Since both the tests are simple and take lesser time to perform, they can be used as rapid diagnostic tests to remove diagnostic dilemma between the two diseases.
Insights
Rapid diagnostic tests for tuberculous meningitis (TBM) using adenosine deaminase (ADA) activity and C-reactive protein (C-RP) show promise. Elevated CSF ADA levels and C-RP positivity can help differentiate TBM from partially treated bacterial meningitis.
Area of Science:
- Neurology
- Infectious Diseases
- Biochemistry
Background:
- Differentiating tuberculous meningitis (TBM) from partially treated bacterial meningitis is clinically challenging.
- Routine cerebrospinal fluid (CSF) tests often show overlapping results between TBM and partially treated bacterial meningitis.
- Accurate and rapid diagnostic methods are crucial for timely and appropriate treatment.
Purpose of the Study:
- To evaluate the utility of adenosine deaminase (ADA) activity and C-reactive protein (C-RP) in CSF for differentiating TBM from partially treated bacterial meningitis.
- To assess the sensitivity and specificity of CSF ADA and C-RP as rapid diagnostic markers.
Main Methods:
- CSF samples were collected from 27 patients with TBM and 8 patients with partially treated bacterial meningitis.
- Adenosine deaminase (ADA) activity and C-reactive protein (C-RP) levels were measured in CSF.
- Routine biochemical tests, including cell count, protein, and sugar concentrations, were also performed.
- Statistical analysis was used to compare ADA levels and determine sensitivity and specificity.
Main Results:
- CSF cell count, protein, and sugar concentrations were comparable between TBM and partially treated bacterial meningitis groups.
- Mean CSF ADA activity was significantly higher in TBM patients compared to partially treated bacterial meningitis patients (p < 0.05).
- Using a cut-off ADA level of <= 5 IU/L and C-RP positivity, sensitivity and specificity were 62.5% and 88.9% for ADA, and 75% and 100% for C-RP, respectively.
Conclusions:
- CSF ADA activity and C-RP detection are valuable rapid diagnostic tests for differentiating TBM from partially treated bacterial meningitis.
- These tests offer a faster and simpler approach to reduce diagnostic uncertainty between these conditions.
- The high specificity of C-RP makes it a particularly useful marker in this diagnostic context.