CSF And Peripheral Blood T-spot.TB Assay Compared With Short-term Anti-tuberculosis For The Diagnose Of Tuberculous Meningitis

Objective In this test, we'd like to compare the sensitivity of short-term anti-tuberculosis treatment in diagnosis of TBM, cerebrospinal fluid(CSF)T-cell enzyme-linked immunospot assay(T-spot.TB) and peripheral blood T-spot.TB, use a definite TBM group; and compare the value of cerebrospinal fluid(CSF) T-spot.TB and peripheral blood T-spot.TB,analysis the value of three methods in diagnosis of TBM.Methods Adult patients(aged ? 18yrs) with suspected TBM and HIV-negative admitted to the first people's hospital of Chenzhou City and the second people's hospital of Chenzhou City, were enrolled prospectively from April 2012 to September 2015. Patients who meet the clinical entry criteria of TBM, would been taken samples of 5ml, 0.5ml and 2ml or more CSF for T-spot.TB, Modified Ziehl-Neelsen stain and MGIT 960 mycobacterial culture, respectively, and 5ml peripheral blood for T-spot.TB, after admission. According to the Consensus tuberculous meningitis diagnosis, the candidates were categorised as definite TBM,probable TBM, possible TBM, or not TBM, give rational short-term anti-tuberculosis treatment to the three former, and collect the results.Collect their clinical data after this test, and exclude those who with incomplete clinical data or indeterminate results, classify them as definite TBM group and not TBM group.Results1. Comparison in the experience group: both CSF T-spot.TB( positive rate87.1%) and peripheral blood T-spot.TB( positive rate 81.4%) has a higher positive rate than short-term anti-tuberculosis( positive rate 67.1%),CSF T-spot.TB(87.1%) has a higher positive rate than short-term anti-tuberculosis, with difference(c2=7.9, P=0.005;c2=3.7, P=0.049); but CSF T-spot.TB( positive rate 87.1%) and peripheral blood T-spot.TB( positive rate 81.4%) has no difference(c2=0.863, P=0.353).2. Use ROC curve evaluate peripheral blood T-spot.TB and CSF T-spot.TB: the sensitive and specificity of peripheral blood T-spot.TB are86.0% and 80.3%, AUC was 0.832, Youden's indx is 0.663, the sensitive and specificity of CSF T-spot.TB are 90.9% and 93.7%, AUC of CSF T-spot.TB is 0.924, Youden's indx is 0.846. Both of their AUC > 0.7, so both them have a high sensitive and specificity.3. Short-term anti-tuberculosis( positive rate 67.1%) is lower than modified ziehl-neelsen stain(95.7%), with difference(c2=18.893, P <0.001), but higher than MGIT 960 mycobacterial culture(positive rate11.4%), with difference(c2=45.549, P < 0.001); modified ziehl-neelsen stain(95.7%) has a higher positive rate than MGIT 960 mycobacterial culture(11.4%), with difference(c2=99.967, P < 0.001).Conclusions Both CSF T-spot.TB AND peripheral blood T-spot.TB have a good detection in diagnose TBM, and they are better than short-term anti-tuberculosis in diagnosis of HIV-negative TBM patients,but short-term anti-tuberculosis still plays a role in diagnosis of tuberculous meningitis.