Diagnostic accuracy of intracellular mycobacterium tuberculosis detection for tuberculous meningitis.
RATIONALE: Early diagnosis and treatment of tuberculous meningitis saves lives, but current laboratory diagnostic tests lack sensitivity. OBJECTIVES: We investigated whether the detection of intracellular bacteria by a modified Ziehl-Neelsen stain and early secretory antigen target (ESAT)-6 in cereb...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
2014
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| _version_ | 1826264533279178752 |
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| author | Feng, G Shi, M Ma, L Chen, P Wang, B Zhang, M Chang, X Su, X Yang, Y Fan, X Dai, W Liu, T He, Y Bian, T Duan, L Li, J Hao, X Liu, J Xue, X Song, Y Wu, H Niu, G Zhang, L Han, C Lin, H |
| author_facet | Feng, G Shi, M Ma, L Chen, P Wang, B Zhang, M Chang, X Su, X Yang, Y Fan, X Dai, W Liu, T He, Y Bian, T Duan, L Li, J Hao, X Liu, J Xue, X Song, Y Wu, H Niu, G Zhang, L Han, C Lin, H |
| author_sort | Feng, G |
| collection | OXFORD |
| description | RATIONALE: Early diagnosis and treatment of tuberculous meningitis saves lives, but current laboratory diagnostic tests lack sensitivity. OBJECTIVES: We investigated whether the detection of intracellular bacteria by a modified Ziehl-Neelsen stain and early secretory antigen target (ESAT)-6 in cerebrospinal fluid leukocytes improves tuberculous meningitis diagnosis. METHODS: Cerebrospinal fluid specimens from patients with suspected tuberculous meningitis were stained by conventional Ziehl-Neelsen stain, a modified Ziehl-Neelsen stain involving cytospin slides with Triton processing, and an ESAT-6 immunocytochemical stain. Acid-fast bacteria and ESAT-6-expressing leukocytes were detected by microscopy. All tests were performed prospectively in a central laboratory by experienced technicians masked to the patients' final diagnosis. MEASUREMENTS AND MAIN RESULTS: Two hundred and eighty patients with suspected tuberculous meningitis were enrolled. Thirty-seven had Mycobacterium tuberculosis cultured from cerebrospinal fluid; 40 had a microbiologically confirmed alternative diagnosis; the rest had probable or possible tuberculous meningitis according to published criteria. Against a clinical diagnostic gold standard the sensitivity of conventional Ziehl-Neelsen stain was 3.3% (95% confidence interval, 1.6-6.7%), compared with 82.9% (95% confidence interval, 77.4-87.3%) for modified Ziehl-Neelsen stain and 75.1% (95% confidence interval, 68.8-80.6%) for ESAT-6 immunostain. Intracellular bacteria were seen in 87.8% of the slides positive by the modified Ziehl-Neelsen stain. The specificity of modified Ziehl-Neelsen and ESAT-6 stain was 85.0% (95% confidence interval, 69.4-93.8%) and 90.0% (95% confidence interval, 75.4-96.7%), respectively. CONCLUSIONS: Enhanced bacterial detection by simple modification of the Ziehl-Neelsen stain and an ESAT-6 intracellular stain improve the laboratory diagnosis of tuberculous meningitis. |
| first_indexed | 2024-03-06T20:09:21Z |
| format | Journal article |
| id | oxford-uuid:2a09e523-06af-4303-a238-0f72da3f99d9 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T20:09:21Z |
| publishDate | 2014 |
| record_format | dspace |
| spelling | oxford-uuid:2a09e523-06af-4303-a238-0f72da3f99d92022-03-26T12:22:40ZDiagnostic accuracy of intracellular mycobacterium tuberculosis detection for tuberculous meningitis.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:2a09e523-06af-4303-a238-0f72da3f99d9EnglishSymplectic Elements at Oxford2014Feng, GShi, MMa, LChen, PWang, BZhang, MChang, XSu, XYang, YFan, XDai, WLiu, THe, YBian, TDuan, LLi, JHao, XLiu, JXue, XSong, YWu, HNiu, GZhang, LHan, CLin, HRATIONALE: Early diagnosis and treatment of tuberculous meningitis saves lives, but current laboratory diagnostic tests lack sensitivity. OBJECTIVES: We investigated whether the detection of intracellular bacteria by a modified Ziehl-Neelsen stain and early secretory antigen target (ESAT)-6 in cerebrospinal fluid leukocytes improves tuberculous meningitis diagnosis. METHODS: Cerebrospinal fluid specimens from patients with suspected tuberculous meningitis were stained by conventional Ziehl-Neelsen stain, a modified Ziehl-Neelsen stain involving cytospin slides with Triton processing, and an ESAT-6 immunocytochemical stain. Acid-fast bacteria and ESAT-6-expressing leukocytes were detected by microscopy. All tests were performed prospectively in a central laboratory by experienced technicians masked to the patients' final diagnosis. MEASUREMENTS AND MAIN RESULTS: Two hundred and eighty patients with suspected tuberculous meningitis were enrolled. Thirty-seven had Mycobacterium tuberculosis cultured from cerebrospinal fluid; 40 had a microbiologically confirmed alternative diagnosis; the rest had probable or possible tuberculous meningitis according to published criteria. Against a clinical diagnostic gold standard the sensitivity of conventional Ziehl-Neelsen stain was 3.3% (95% confidence interval, 1.6-6.7%), compared with 82.9% (95% confidence interval, 77.4-87.3%) for modified Ziehl-Neelsen stain and 75.1% (95% confidence interval, 68.8-80.6%) for ESAT-6 immunostain. Intracellular bacteria were seen in 87.8% of the slides positive by the modified Ziehl-Neelsen stain. The specificity of modified Ziehl-Neelsen and ESAT-6 stain was 85.0% (95% confidence interval, 69.4-93.8%) and 90.0% (95% confidence interval, 75.4-96.7%), respectively. CONCLUSIONS: Enhanced bacterial detection by simple modification of the Ziehl-Neelsen stain and an ESAT-6 intracellular stain improve the laboratory diagnosis of tuberculous meningitis. |
| spellingShingle | Feng, G Shi, M Ma, L Chen, P Wang, B Zhang, M Chang, X Su, X Yang, Y Fan, X Dai, W Liu, T He, Y Bian, T Duan, L Li, J Hao, X Liu, J Xue, X Song, Y Wu, H Niu, G Zhang, L Han, C Lin, H Diagnostic accuracy of intracellular mycobacterium tuberculosis detection for tuberculous meningitis. |
| title | Diagnostic accuracy of intracellular mycobacterium tuberculosis detection for tuberculous meningitis. |
| title_full | Diagnostic accuracy of intracellular mycobacterium tuberculosis detection for tuberculous meningitis. |
| title_fullStr | Diagnostic accuracy of intracellular mycobacterium tuberculosis detection for tuberculous meningitis. |
| title_full_unstemmed | Diagnostic accuracy of intracellular mycobacterium tuberculosis detection for tuberculous meningitis. |
| title_short | Diagnostic accuracy of intracellular mycobacterium tuberculosis detection for tuberculous meningitis. |
| title_sort | diagnostic accuracy of intracellular mycobacterium tuberculosis detection for tuberculous meningitis |
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