| Tuberculosis(TB)is a cosmopolitan problem of public health. Tuberculous Meningitis(TBM) is the most common and serious extrapulmonary tuberculosis.The morbility of Tuberculous Meningitis(TBM) in TB is 10%-20% and the mortality is 15%-30%. It is very important of early diagnosis and early treatment to the prognosis of TBM. According to the clinical manifestation and the change of cerebrospinal fluid, it is difficult to distinguish the TBM with viral meningitis, purulent meningitis and cryptococcal meningitis.Tuberculosis antibody with ELISA assay, acid-fast staining, bacterial culture of cerebrospinal fluid, cerebrospinal fluid biochemistry and a PPD skin test has been used as the laboratory diagnosis of TBM,but it is not satisfactory of the bacterial culture of cerebrospinal fluid and acid-fast staining as the final diagnosis because of poor specificity and sensitivity.So it is necessary to reseach a new technique for the early diagnosis in tuberculosis mengitis individuals. T SPOT-TB is a new enzyme-linked immunospot assay for diagnosing latent tuberculosis (TB) infection with tuberculosis antigen-specific T cells,It is reported by Mahairas in 1996 that the sequences named RD1 can be found in pathogenic mycobacterium tuberculosis not in Bacille Calmette-Guérin vaccination and mycobacterium. ESAT-6and CFP-10(culture filtrate protein)encoded by RD1 are specific antigen to IFN-gamma- secreting T cells, T SPOT-TB is a new technique to detect the tuberculosis antigen-specific T cells in PBMC,which can secrete the IFN-gamma stimulating by pathogenic tuberculosis antigen. ELISPOT was applied to screen patients with tuberculosis infection by detecting antigen-specific lymphocytes in England and Americ,but not put to use in clinical in china. As we known, the immune response is the same in tuberculosis meningitis as in lung tuberculosis, so T SPOT-TB can be applied to diagnose latent tuberculous meningitis.Objective:To evaluate the application of T SPOT-TB in diagnosing tuberculous meningitis individualis by detecting IFN-gamma-secreting T cells.Methods:30 cases short of fourteen days onset with tuberculous meningitis were enrolled from 2007,10 to 2009,4 in infectious disease department of the first affiliated hospital of nanchang university. 15 cases with non-tuberculous meningitis( including 5 cases with viral meningitis,5 cases with purulent meningitis and 5 cases with cryptococcus meningitis ) were as the control. Eight millilitre anticoagulated blood were drawed to disassociate mononuclearcells. The T SPOT-TB assay was employed to detect IFN-gamma-secreting T cells, Tuberculosis antibody with ELISA assay, acid-fast staining, bacterial culture of cerebrospinal fluid and a PPD skin test were performed on all patients as a positive control.Results:1.Using the ELISPOT assay to detect IFN-gamma-secreting T cells,positivity rates for tuberculous meningitis and non-tuberculous meningitis were 90%(27/30) ande13.3%(2/15).2.Using ELISA assay to detcet the tuberculosis antibody of CSF, positivity rates for tuberculous meningitis and non-tuberculous meningitis were 16.7%(5/30) ande 13.3%(2/15).3. Acid-fast staining of CSF: positivity rates for tuberculous meningitis andnon -tuberculous meningitiswere 13.3%(4/30) ande0%(0/15).4.Bacterial culture of CSF:positivity rates for tuberculous meningitis and non- tuberculous meningitis were 0%(0/30) ande0.6%(1/15).5.A PPD skin test :positivity rates for tuberculous meningitis and nontuberculous meningitis were 53.3%(16/30) ande40%(6/15).It is more sensitive and specific of the ELISPOT assay to detect IFN- gamma- secreting T cells(T spot-TB) in the diagnosis in tuberculous meningitis individuals than tuberculosis antibody with ELISA assay, acid-fast staining, bacterial culture of cerebrospinal fluid and a PPD skin test .Conclusions:The ELISPOT assay to detect IFN-gamma-secreting T cells(T spot-TB) appears to be better in detecting tuberculosis infection, which will be a useful and auxiliary tool in early diagnosis in tuberculosis mengitis individuals. |
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