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Actividad de la isoenzima ada2 en líquido cefalorraquídeo como ayuda diagnóstica en tuberculosis meníngea HNGAI Setiembre 1999- Enero 2000Barrón Pastor, Helí Jaime, Cisneros Chinchay, Ruth Isela January 2000 (has links)
Se realizó un estudio de isoenzimas de Adenosina Deaminasa (Adenosina Aminohidrolasa, EC 3.5.4.4), en líquido cefalorraquídeo de pacientes con Tuberculosis Meníngea y otras enfermedades del sistema nervioso central con actividad ADA incrementado; utilizando la técnica estandarizada de electroforesis en gel de poliacrilamida (método electroforético de Laemmli modificado), una técnica de revelado enzimático y la densitometria para distinguir las isoenzimas en cada grupo. Se evaluaron 19 muestras de LCR de pacientes con cuadro clínico de TBC meníngea. al momento de obtener las muestras, los pacientes no tenían diagnóstico confirmatorio; posteriormente se realizó la correlación c1ÍPjca respectiva. Para corroborar la baja frecuencia de esta enfermedad se realizó la revisión de las historias clínicas desde un año antes (setiembre 1998 - agosto 1999). Para el ensayo se consideró las muestras que tenían actividad ADA mayor de 9 UIL, determinado por el método espectrofométrico de Giusti y Galanti, las cuales fueron conservadas a - 40°C hasta la corrida electroforética. Para cada carril se aplicó 120 ul de muestra, y la corrida fue realizada en un sistema de electroforesis vertical usando buffer fosfato 0.1 M a pH 6.7. Se encontró que las medianas de las actividades de adenosina deaminasa totales en LCR de pacientes con TBC meníngea son mayores que ei LCR de otras enfermedades parainfectivas del SNC. De otro lado ADA1m tuvo muy poca contribución a la actividad ADA total tanto en TBC meníngea como en otras patologías; ADA1cp tuvo mayor contribución de la actividad ADA total para ambos grupos, mostrándose mayor en las enfermedades no TBC meníngea y la contribución ADA2 mostró un incremento en tuberculosis meníngea respecto de otras enfermedades del SNC. Se concluye que la electroforesis de LCR es una herramienta que permite distinguir las isoenzimas ADA; evidenciando la presencia de niveles elevados de isoenzima ADA2 en TBC meníngea, como consecuencia del incremento de la línea celular monocito-macrófago en LCR.
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Clinical value of a uniform research case definition of tuberculous meningitisWessels, Marie 04 1900 (has links)
Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: BACKGROUND: Tuberculous meningitis (TBM) research remains important but
obtaining adequate sample sizes of microbiologically-confirmed TBM cases is difficult,
therefore clinical cases of TBM need to be included. A uniform research case definition
for TBM was developed to assist diagnostic standardization.
METHODS: Our study evaluated the proposed uniform research case definition in a
group of children diagnosed with TBM. A subgroup of 66 children with cultureconfirmed
TBM was compared to culture-confirmed bacterial meningitis controls.
RESULTS: The uniform case definition was applied to 554 TBM patients. Sixty-six
(11.9%) patients had definite TBM, 408 (73.6%) had probable TBM and 72 (13.0%) had
possible TBM. Symptom duration >5 days, weight loss or persistent cough >2 weeks,
recent TB contact, focal neurological deficit, clear cerebrospinal fluid (CSF) appearance
and basal meningeal enhancement predicted TBM when compared to definite bacterial
meningitis with a sensitivity and specificity of 97.0% and 93.7%, respectively. When
using a probable TBM score as the diagnostic measure, sensitivity was 86% and
specificity was 100%. When using a possible TBM score as the diagnostic measure,
sensitivity was 100% but specificity was 56%.
CONCLUSION: The uniform research case definition for TBM performed well when
using a probable TBM score as the diagnostic marker. A regression model also
differentiated TBM from bacterial meningitis with good accuracy, but caution is needed
in its application to early TBM.
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Estudio comparativo de la eficacia y seguridad de esquemas de tratamiento corto (6 meses) y largo (12 meses) para meningitis tuberculosa. Lima - Perú. Enero 2000 - diciembre 2003Alvarado Rosales, Manuel Anastacio January 2007 (has links)
Compara la eficacia y seguridad de los regímenes de tratamiento largo de 12 meses y el corto de 6 meses en el tratamiento de la meningitis tuberculosa. Realiza un estudio es de tipo analítico, comparativo, retrospectivo y observacional. La muestra estuvo comprendida por todos los pacientes con meningitis tuberculosa diagnosticados en el Hospital Nacional Dos de Mayo (HNDM) y del
Instituto Especializado en Ciencias Neurológicas IECN ”Oscar Trelles Montes”
durante el período comprendido entre enero 2000 - diciembre 2003 que cumplieron con
todos los criterios de inclusión y ninguno de exclusión. Los pacientes fueron asignados
al grupo 1 (pacientes con indicación de curso largo de 12 meses de tratamiento con isoniazida, rifampicina, pirazinamida y etambutol los primeros 2 meses, luego Isoniazida, rifampicina por 10 meses) y el grupo 2 (todos los pacientes con indicación de curso corto de 6 meses de tratamiento con isoniazida,
rifampicina, pirazinamida y etambutol los primeros 2 meses, luego isoniazida,
rifampicina por 4 meses). Se revisaron las historias clínicas de los pacientes de ambos grupos de estudio y se evaluó las variables clínicas, epidemiológicas, exámenes de laboratorio, presencia de recaídas, fracaso terapéutico, mortalidad, curación y secuelas luego de concluir el tratamiento
completo por lo menos hace dos años. Los datos fueron llenados en un instrumento de
recolección de datos. Se realizó una visita domiciliaria a los pacientes de ambos grupos de tratamiento (grado II), los cuales fueron entrevistados y se les realizó una evaluación neurológica integral.
Luego se comparó la mortalidad, recaídas, efectos adversos y secuelas en los pacientes
con meningitis tuberculosa sometidos a los regímenes de tratamiento largo de 12 meses
y corto de 6 meses. Para determinar si existió asociación estadística entre variables
cualitativas se empleó la prueba Chi cuadrado de Mantel-Haenzel con ajuste para las
variables edad y sexo; para las variables cualitativas se empleó la prueba t de Student.
En el archivo del Programa Nacional de Tuberculosis (PCT) del
IECN se registraron durante el período de estudio (enero 2000 – diciembre 2003) 72
casos de meningitis tuberculosa en inmunocompetentes, de los cuales se ubicaron 69
historias clínicas y 55 cumplieron los criterios de inclusión. En el archivo del PCT del
HNDM se registraron durante el período de estudio 133 pacientes con meningitis
tuberculosa en inmunocompetentes, de los cuales se ubicaron 76 historias clínicas y 53
cumplieron con los criterios de inclusión. Se presentaron 26 pacientes con meningoencefalitis grado I de los cuales 10 habían sido asignados al esquema de tratamiento largo y 16 al esquema corto; 51 pacientes con meningoencefalitis grado II, 27 de los cuales habían sido asignados al esquema de
tratamiento largo y 24 al esquema corto; y 31 pacientes con meningoencefalitis grado
III siendo 13 asignados al esquema de tratamiento corto y 18 al esquema largo. Los
grupos asignados a los esquemas largo y corto en términos generales no difirieron
significativamente en cada grado de la enfermedad siendo estadísticamente
comparables. Al evaluarse la eficacia de los regímenes de tratamiento largo y corto no se encontró
diferencia estadísticamente significativa en los grados I, II y III; tampoco existió
diferencia estadísticamente significativa en la frecuencia de reacciones adversas a
fármacos antituberculosos (RAFAs), en la mortalidad, en la frecuencia de secuelas así
como discapacidad (grado II). Concluye que los esquemas de tratamiento antituberculoso largo (12 meses) y corto (6 meses) en el tratamiento de la meningoencefalitis tuberculosa tienen similar
eficacia y seguridad y el esquema de tratamiento corto no está asociado a mayor
frecuencia de recaídas en comparación a el esquema de tratamiento largo. / Trabajo académico
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Childhood tuberculous meningitis : challenging current management strategiesVan Toorn, Ronald 04 1900 (has links)
Thesis (PhD)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Tuberculous meningitis (TBM) continues to be an important cause of mortality and
neurological disability in resource-limited countries. Many questions remain about the
best approaches to prevent, diagnose, and treat TBM, and there are still too fewanswers.
The aim of this dissertation was to challenge current management strategies in
childhood TBM.
Accurate prediction of outcome in TBM is of critical importance when assessing the efficacy
of different interventions. I conducted a retrospective cohort study of 554 children with
TBM less than 13 years of age admitted to Tygerberg Children’s Hospital over a 20
year period (1985-2005) and reclassified all patients according to the criteria of all the
currently available staging systems in childhood TBM (chapter 4). In this study, I found that
the “Refined Medical Research Council (MRC) staging system after 1 week” had the
highest predictive value of all TBM staging systems. It is created by subdivision of stage
2 (2a and 2b) of the existing MRC staging system. Additionally, I proposed and validated
a simplified TBM staging system which is less dependent on clinical ability and
neurological expertise than current staging systems. The simplified staging system was
termed the “Tygerberg Children’s Hospital Scale” (TCH) and relies solely on the patient’s
ability to visually fixate and follow and the motor response to pain on both sides. It
demonstrated excellent predictive power of outcome after 1 week and did not differ
significantly from the “Refined MRC staging system” in this regard.
The optimal anti-TB drug regimen and duration of treatment for TBM is unknown. It has
been suggested that intensive short-course (6 months) anti-TB therapy may be sufficient
and safe. I conducted a prospective descriptive study of 184 consecutively treated children
with TBM and found that short-course intensified anti-TB therapy aimed at treating TBM
patients (anti-TBM therapy) is sufficient and safe in both HIV-uninfected and HIVinfected
children with drug susceptible TBM (chapter 5). The overall study mortality of
3.8% at completion of treatment compares favourably with the median mortality rate of 33% (range 5-65%) reported in a recent review describing outcome in TBM treatmentstudies.
TB-immune reconstitution inflammatory syndrome (IRIS) is a potentially life-threatening
complication in HIV-infected children with TB of the central nervous system. Little is
known about the incidence, case fatality, underlying immunopathology and treatment
approaches in HIV-infected children with neurological TB-IRIS. In a case series, I found
that neurological TB-IRIS should be considered when new neurological signs develop after
initiation of antiretroviral therapy (ART) in children with TBM (chapter 6.1). Manifestations
of neurological TB-IRIS include headache, seizures, meningeal irritation, a decreased
level of consciousness, ataxia and focal motor deficit. I also discussed the rational for
using certain treatment modalities, includingthalidomide.
Neurological tuberculous mass lesions (tuberculomas and pseudo-abscesses) may develop or
enlarge in children on anti-TBM treatment. These lesions respond poorly to therapy, and
may require surgical excision, but may be responsive to thalidomide, a potent inhibitor of
tumour necrosis factor-alpha (TNF-alpha). The optimal dose and duration of thalidomide
therapy and the correlation with magnetic resonance imaging (MRI) is yet to be explored.
The primary objective of our next study was to investigate whether serial MRI is useful
in evaluating treatment response and duration of thalidomide therapy (chapter 6.2). A
secondary objective was to determine the value of thalidomide in the treatment of these
lesions. In a prospective observational study over three years, serial MRI was performed
in 16 consecutive children compromised by TB pseudo-abscesses who were treated with
thalidomide. The rapid clinical response of most patients suggests that thalidomide provides
substantial clinical benefit in this clinical context. I also identified a MRI marker of cure
that is evolution of lesions from early stage “T2 bright” with edema to “T2 black.” This
finding could be useful in the future management of these patients.
Transcranial Doppler imaging (TCDI) is potentially a valuable investigational tool in
children with TBM, a condition often complicated by pathology relevant to Doppler
imaging such as raised intracranial pressure (ICP) and cerebral vasculopathies. Serial TCDI
was performed on 20 TBM children with the aim of investigating cerebral haemodynamics and the relationship between pulsatility index (PI) and ICP (chapter 6.3). In this study, I
found that TCDI-derived pulsatility index (PI) is not a reliable indicator of raised ICP in
children with tuberculous hydrocephalus which I attributed this to individual variation of
tuberculous vascular disease, possibly compromising cerebral vascular compliance and
resistance. The study did confirm the efficacy of medical therapy in children with
tuberculous communicating hydrocephalus. In all cases, the ICP normalized within 7 days
after initiation of acetazolamide and furosemide.
In the same cohort of children with TBM I also measured cerebral blood flow velocities
(BFV) in the anterior cerebral artery (ACA), middle cerebral artery (MCA) and posterior
cerebral artery (PCA) on admission and after day 3 and 7. I found persistent high BFV in all
the basal cerebral arteries suggesting stenosis due to vasculitis rather than functional
vasospasm. Additionally, I found that complete MCA occlusion, subnormal mean MCA
velocities (less than 40 cm/s) and a reduced PI (less than 0.4) correlated with radiological
proven large cerebral infarcts. No side-to-side differences in MCA BFV or subnormal PI’s
were detected in four TBM children with territory infarcts on admission. I attributed this to
the occlusion of a limited number (one or two) of the 9 MCA perforators which has been
shown not to affect the hemodynamics of the MCA.
I concluded by highlighting the many questions that remain about the best approaches to
prevent, diagnose, and treat TBM (chapter 2). In a second literature review, aimed at
clinicians working in resource-limited countries, I describe novel approaches to the
management of childhood TBM, including a treatment algorithm for tuberculous
hydrocephalus, the role for short-course intensified anti-TBM treatment and home-based
anti-TBM treatment (chapter 3).
Even with the best diagnostic and treatment modalities, outcome in childhood TBM will
remain poor if diagnosis is delayed. Our efforts should be on increased awareness and earlier
diagnosis. / AFRIKAANSE OPSOMMING: Tuberkuleuse meningitis (TBM) bly ‘n belangrike oorsaak van mortaliteit en neurologiese
ongeskiktheid in lande met beperkte hulpbronne. Baie vrae oor die beste benaderings tot
voorkoming, diagnose en behandeling van TBM bly bestaan en daar is steeds te min antwoorde.
Die doel van die verhandeling was om huidige behandelingstrategieë van tuberkuleuse
meningitis (TBM) in kinders uit te daag.
Akkurate voorspelling oor die uitkoms van TBM is van kritieke belang wanneer
doeltreffendheid van verskillende ingrypings beoordeel word. Ek het ‘n retrospektiewe kohort
studie van 554 kinders jonger as 13 jaar met TBM wat in Tygerberg Kinderhospitaal toegelaat is
oor `n tydperk van twintig jaar (1985 tot 2005) uitgevoer en al die pasiënte volgens die
kriteria van al die huidig beskikbare stadiëringsisteme vir kinder TBM geherklassifiseer
(hoofstuk 4). Die waarde van die verskillende stadiëringsisteme in die voorspelling van
neurologiese uitkoms is toe bepaal. In hierdie studie het ek bevind dat die “Verfynde Mediese
Navorsings Raad (MNR) stadiëringsisteem na 1 week” die TBM stadiëringsisteem met die
hoogste voorspellende waarde was om neurolgiese uitkoms te voorspel. Dit is geskep deur
onderverdeling van stadium 2 (2a en 2b) van die bestaande gemodifiseerde MNR
stadiëringsisteem. Daarbenewens het ek ’n vereenvoudigde stadiëringsisteem vir TBM wat
minder afhanklik van kliniese vermoëns en neurologiese kundigheid sal wees as die bestaande
stadiëringsisteme daargestel en getoets. Die vereenvoudigde stadiëringsisteem is die “Tygerberg
Kinderhospitaal Skaal (TKH)” genoem en dit is slegs gebaseer op `n pasiënt se vermoë
om visueel te fikseer en te volg en die motoriese respons tot pyn aan beide kante van die
ligaam. Dit het uitstekende voorspellingswaarde gehad vir uitkoms na die eerste week van
siekte en het in hierdie verband nie betekenisvol verskil van die “Verfynde MNR
stadiëringsisteem” nie.
Die optimale anti-TB middel regimen en duurte van behandeling vir TBM is onbekend.
Sommige kenners stel voor dat ‘n intensiewe kort-kursus (6 maande) van anti-TB behandeling
veilig en voldoende mag wees. Ek het ‘n prospektiewe beskrywende studie op 184
opeenvolgende kinders met TBM uitgevoer en bevind dat intensiewe kort-kursus anti-TB
behandeling gemik op die behandeling van kinders met TBM (anti-TBM behandeling) in beide menslike immuniteitgebrekvirus (MIV)-ongeïnfekteerde en MIV-geïnfekteerde kinders met
middel-gevoelige TBM voldoende en veilig was (hoofstuk 5 ). Die mortaliteit in my studie met
voltooing van behandeling vergelyk gunstig met die mediane mortaliteit van 33% (reikwydte
5-65%) wat onlangs in ‘n oorsig van uitkoms in TBM gerapporteer is.
TB immuun rekonstitusie inflammatoriese sindrome (IRIS) is ‘n potensieël lewensbedreigende
komplikasie in MIV-geïnfekteerde kinders met TB van die sentrale senuwee sisteem (SSS). Min
is oor die voorkoms, mortaliteit, onderliggende immunopatologie en behandelingsbenaderings in
MIV-geïnfekteerde kinders met neurologiese TB-IRIS bekend. In `n gevalle-reeks het ek gevind
dat neurologiese TB-IRIS oorweeg moet word as nuwe neurologiese tekens na aanvang van
antiretrovirale terapie (ART) in MIV-geïnfekteerde kinders met TBM ontwikkel (hoostuk 6.1).
Simptome en tekens van neurologies TB-IRIS behels hoofpyn, konvulsies, meningiale
prikkeling, ‘n verlaagde vlak van bewussyn, ataksie en fokale motoriese uitval. Ons bespreek
ook die rasionaal vir die gebruik van sekere behandelingsmodaliteite, insluitende thalidomied.
Neurologiese tuberkuleuse massaletsels (tuberkulome en pseudo-absesse) mag ontwikkel of
vergroot in kinders op anti-TBM behandeling. Hierdie letsels reageer swak op terapie, vereis
soms chirurgiese verwydering, maar kan op talidomied behandeling reageer, ‘n kragtige
inhibeerder van tumor nekrose faktor-alfa (TNF-α). Die optimale dosis en duurte van
thalidomide behandeling en die korrelasie met magnetiese resonansbeelding (MRB) moet nog
ondersoek word. Die primêre doel van my volgende studie was om te bepaal of seriële MRB
van waarde is om die respons op behandeling te evalueer asook die duurte van talidomied
behandeling. Die sekondêre doelwit was om die waarde van talidomied in die behandeling van
hierdie letsels te bepaal. In ‘n prospektiewe waarnemingstudie wat oor 3 jaar gestrek het is
seriële MRB uitgevoer op 16 opeenvolgende kinders met TB pseudo-absesse wat behandel is
met talidomied (hoofstuk 6.2). Die spoedige kliniese verbetering van die meeste pasiënte dui
daarop dat thalidomied `n aansienlike kliniese voordeel bied in hierdie kliniese konteks.
Verder het ek `n MRB merker van genesing geïdentifiseer naamlik evolusie van die letsel van
vroeë stadium “T2 helder” met edeem na “T2 swart”. Hierdie bevinding is van groot waarde in
die toekomstige behandeling van TBM pasiënte wat hierdie komplikasie ontwikkel.
Transkraniale Doppler beelding (TKDB) is potensieël `n waardevolle ondersoekmetode in
kinders met TBM, `n toestand wat dikwels gekompliseer word deur patologie verwant aan Doppler beelding soos verhoogde intrakraniale druk (IKP) en serebrale vaskulopatieë. Seriële
TKBD is op 20 TBM kinders uitgevoer om serebrale hemodinamika en die verband tussen die
pulsatiele indeks (PI) en IKP te ondersoek (hoofstuk 6.3). In hierdie studie het ek gevind dat
TKDB-afgeleide PI nie `n betroubare aanduiding van verhoogde IKD in kinders met
tuberkuleuse hidrokefalus is nie en dit aan individuele variasies van tuberkuleuse vaskulêre siekte
toegeskryf, wat serebrale vaskulêre toegeeflikheid en weerstand benadeel. Die studie het die
doeltreffendheid van mediese behandeling in kinders met kommunikerende tuberkuleuse
hidrokefalus bevestig. In alle gevalle het die IKP binne 7 dae na aanvang van asetosoolamied en
furosemied genormaliseer.
In dieselfde groep TBM kinders het ek die serebrale bloedvloei-snelhede (BVS) in die anterior
serebrale arterie (ASA), middel serebrale arterie (MSA) en posterior serebrale arterie (PSA) met
toelating en na dag 3 en 7 gemeet. Ek het volgehoue hoё BVS in al die basale arteries gevind
wat op stenose sekondêr tot vaskulitis eerder as funksionele vasospasma dui. Daarbenewens het
ek gevind dat volledige MSA afsluiting, subnormale gemiddelde MSA snelhede (minder as
40 sentimeter per sekonde) en `n verminderde PI (minder as 0.4) met radiologies-bewysde groot
serebrale infarksies gekorreleer het. Geen kant-tot-kant verskille in MSA BVS of subnormale
PI’s is in vier TBM kinders met kleiner infarksies met toelating bespeur nie. Ek skryf dit toe aan
die afsluiting van `n beperkte aantal (een of twee) van die nege MSA perforators wat nie nie
die hemodinamika van die MSA beïnvloed nie.
Ek het afgesluit om al die vrae wat nog bestaan oor die beste benadering ten opsigte van
voorkoming, diagnose and behandeling van TBM uit te wys (hoofstuk 2). In die tweede
literatuuroorsig, wat gemik is op dokters wat werk in hulpbron-beperkte lande, beskryf ek nuwe
benaderings tot die hantering van pediatriese TBM, insluitend `n behandelingsalgoritme vir
tuberkuleuse hidrokefalus, die rol van kort- kursus versterkte anti-TB behandeling vir TBM en
tuis-gebaseerede anti-TBM behandeling (hoofstuk 3). Selfs met die beste diagnostiese en behandelingsmodaliteite, is die uitkoms van kinder TBM
swak indien diagnose vertraag word. Ons pogings moet daarom op groter bewustheid en
vroeёr diagnose berus.
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Aids for the early diagnosis of tuberculous meningitis (TBM)Ramkissoon, Arthi. January 1985 (has links)
Mortality and morbidity rates associated with tuberculous meningitis (TBM) are substantial. The average duration of the untreated disease from onset to death is about 17 days. The prognosis of TBM is known to correlate with the stage of the disease at the time of diagnosis and commencement of chemotherapy. Early diagnosis improves the chances of recovery without neurological sequelae. Early diagnosis is a problem because the presenting symptoms are non-specific and the onset of the disease is typically insidious.
To date no single test is available that is totally reliable and specific for TBM. I have attempted to develop a reliable and easily applicable test for the diagnosis of TBM. In fulfilling this objective, the work undertaken may be divided into three major sections:- 1. Detection of soluble Mycobacterium tuberculosis antigens in the cerebrospinal fluid (CSF) of patients with TBM and in control groups by using Mycobacterium bovis BCG antigens. The technique used was that of inhibition enzyme-linked immunosorbent assay (ELISA). The principle of this technique is illustrated in Fig. 5. 2. Detection of soluble M. tuberculosis antigens in the CSF of tuberculous and control groups of patients by using antibodies raised against M.bovis BCG. The technique used was that of the double antibody sandwich ELISA. An outline of this ELISA is given in Fig. 6. 3. Correlation of chloride levels in the blood and CSF of patients with tuberculous and other forms of meningitis. It has been established that the SERUM/CSF ratio of bromide tends towards unity in patients with TBM because the permeability of the blood-brain barrier is impaired. Since both bromide and chloride are chemically similar (both being halides), it was thought that a similar pattern may exist for BLOOD/CSF chloride ratios; and this was investigated. The method used for the INHIBITION ELISA had to be standardized
before the samples could be tested. This involved investigating the acceptability of various microtitre plates; determination of the optimal working dilutions for the coating solution and conjugate; and determination of optimal conditions for the various incubation periods, both in terms of time and temperature. A total of 70 specimens was tested. These consisted of 25 normal CSF controls; 25 pleural and ascitic fluid samples; 10 TBM samples, and 10 bacterial meningitis CSF samples. It was found that a distinction
existed between the absorbance values obtained from positive TBM CSF samples (Mean 0,658 + 0,043) and that from normal CSF samples (Mean 1,089 + 0,224). The mean absorbance of the culture-positive bacterial CSF's also differed significantly from the other 2 groups (Tables VII; IX). Some overlap occurred amongst the absorbance values of bacterial culture positive CSF's (Range 0,975-0,879) and normal CSF's (Range 1,486-0,934). The mean absorbance value for bacterial positive CSF samples (0,920 _+ 0,029) differed significantly (p <0,01) from those of normal CSF (1,089 + 0,224) and TBM CSF's (0,658 + 0,043). The difference between the mean values obtained with tuberculous and non-tuberculous groups of pleural and ascitic fluid was also
significant (p < 0,01). The method used for the DOUBLE ANTIBODY SANDWICH ELISA was that of Sada et al. (1983). Before the samples could be tested, the method had to be standardized and similar investigations to those for the INHIBITION ELISA were performed. In addition, antibodies raised
against M.bovis BCG were conjugated to alkaline phosphatase since
no commercial preparation was available. Unfortunately no distinction
was recorded between negative and positive test specimens, even on
repetition of the entire procedure. Measurement of chloride was done by a fully automated procedure using the BECKMAN ASTRA-8. A total of 149 samples were tested. Of these 10 were tuberculous, 34 were viral, and the remainder were bacterial meningitis. No pattern was established that could differentiate TBM from viral or bacterial meningitis. The results obtained are tabulated in Table III and illustrated in Figures 9, 10, and 11. In summarizing, the use of the INHIBITION ELISA technique for the accurate diagnosis of TBM seems promising. However, its validity in the clinical situation will have to be assessed further and with greater numbers of specimens before it can be adopted as a diagnostic procedure for TBM. OBJECTIVE. To determine
1. The ability and reliability of the INHIBITION ELISA1 technique to detect mycobacterial antigens in pleural, ascitic, and cerebrospinal fluids. 2. The accuracy and reproducibility of the double antibody sandwich ELISA in the detection of mycobacterial antigens in CSF of patients with tuberculous meningitis (TBM). 3. Whether a correlation exists between blood and CSF chloride levels in patients with tuberculous and other forms of meningitis. / Thesis (M.Med.Sc.)-University of Natal, Durban, 1985.
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Sensibilidad, especificidad y valores predictivos del test de adenosin desaminasa (ADA) en el diagnóstico de meningitis tuberculosa en pacientes infectados con el VIHLeón Robles, Caridad Pilar January 2007 (has links)
Objetivo: Determinar la sensibilidad, especificidad, valor predictivo positivo y negativo del TEST de ADA en el diagnostico de Meningoencefalitis tuberculosa (MEC-TB) en pacientes de ambos sexos infectados con el VIH, hospitalizados en los pabellones de Medicina Interna del Hospital Nacional Arzobispo Loayza (HNAL). Periodo Enero-Diciembre 2006 Material y Métodos: Se realizó un estudio Transversal donde se revisó 201 historias clínicas de pacientes con VIH/SIDA hospitalizados durante Enero-Diciembre 2006. Solo 48 cumplieron los criterios de selección. Resultados: 29 casos fueron varones (60.4%) y 19 mujeres (39.5%). El rango de edades donde se concentro la mayor proporción de casos fue de 26 a 35 años (39.5%). Se encontró Meningitis Tuberculosa en 16 casos (33.3%), Meningocriptococosis 20 casos (41.6%), Toxoplasmosis cerebral 6 casos (12.5%), MEC viral 4 casos (10.4%), y un proceso neoplásico. La prevalencia de MEC-TB fue de 33.3%. Así también la Sensibilidad fue de 93.8 (71.7- 98.9), la especificidad de 71.9 (84.5- 59.6) y los valores predictivos positivo y negativo fueron de 62.5 (42.7-78.8) y 95.8 (79.8- 99.3) respectivamente, con un nivel de confianza del 95%. La Curva de ROC dio como punto de corte 6.1U/L con sensibilidad de 93.8% y especificidad de 71.9%, encontrándose un área de 89% bajo la curva Conclusión: El test de ADA es una prueba confiable para el diagnostico de MEC-TB en pacientes con VIH / Objective: To determine sensitivity, specificity, positive and negative predictive value of the ADA TEST for the tuberculous Meningoencephalitis (TB-MEC) diagnosis in both sexes patients infected with the HIV, hospitalized at the Internal Medicine pavilions of the “Arzobispo Loayza National Hospital”. January – December 2006. Material and Methods: A Cross-sectional study was made. 201 clinical histories of patients with HIV/AIDS hospitalized during January - December 2006 were reviewed. Only 48 histories fulfilled the selection criteria. Results: 29 cases were men (60.4%) and 19 women (39.5%). The greater proportion of cases was found in the range from 26 to 35 years (39.5%). There was found tuberculous meningitis in 16 cases (33.3%), cryptoccocal meningitis in 20 cases (41.6%), cerebral toxoplasmosis in 6 cases (12.5%), viral meningoencephalitis in 4 cases (10.4%), and one neoplasic case. The prevalence of tuberculous meningoencephalitis was 33.3%. The sensitivity was 93,8 (71,7- 98,9), the specificity was 71,9 (84,5- 59,6) and the predictive values positive and negative were 62,5 (42.7-78.8) and 95,8 (79,8- 99,3) respectively, with a 95% of confidence value. The ROC Curve gave a 6.1 U/L as cut point with a sensitivity of 93,8% and a specificity of 71.9%, with an area under the curve of 89%. Conclusion: The ADA test is a reliable test for the diagnosis of tuberculous meningoencephalitis in HIV patients.
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Sensibilidad, especificidad y valores predictivos del test de adenosin desaminasa (ADA) en el diagnóstico de meningitis tuberculosa en pacientes infectados con el VIHLeón Robles, Caridad Pilar January 2007 (has links)
Objetivo: Determinar la sensibilidad, especificidad, valor predictivo positivo y negativo del TEST de ADA en el diagnostico de Meningoencefalitis tuberculosa (MEC-TB) en pacientes de ambos sexos infectados con el VIH, hospitalizados en los pabellones de Medicina Interna del Hospital Nacional Arzobispo Loayza (HNAL). Periodo Enero-Diciembre 2006.
Material y Métodos: Se realizó un estudio Transversal donde se revisó 201 historias clínicas de pacientes con VIH/SIDA hospitalizados durante Enero-Diciembre 2006. Solo 48 cumplieron los criterios de selección.
Resultados: 29 casos fueron varones (60.4%) y 19 mujeres (39.5%). El rango de edades donde se concentro la mayor proporción de casos fue de 26 a 35 años (39.5%). Se encontró Meningitis Tuberculosa en 16 casos (33.3%), Meningocriptococosis 20 casos (41.6%), Toxoplasmosis cerebral 6 casos (12.5%), MEC viral 4 casos (10.4%), y un proceso neoplásico. La prevalencia de MEC-TB fue de 33.3%. Así también la Sensibilidad fue de 93.8 (71.7- 98.9), la especificidad de 71.9 (84.5- 59.6) y los valores predictivos positivo y negativo fueron de 62.5 (42.7-78.8) y 95.8 (79.8- 99.3) respectivamente, con un nivel de confianza del 95%. La Curva de ROC dio como punto de corte 6.1U/L con sensibilidad de 93.8% y especificidad de 71.9%, encontrándose un área de 89% bajo la curva.
Conclusión: El test de ADA es una prueba confiable para el diagnostico de MEC-TB en pacientes con VIH. / Objective: To determine sensitivity, specificity, positive and negative predictive value of the ADA TEST for the tuberculous Meningoencephalitis (TB-MEC) diagnosis in both sexes patients infected with the HIV, hospitalized at the Internal Medicine pavilions of the “Arzobispo Loayza National Hospital”. January – December 2006.
Material and Methods: A Cross-sectional study was made. 201 clinical histories of patients with HIV/AIDS hospitalized during January - December 2006 were reviewed. Only 48 histories fulfilled the selection criteria.
Results: 29 cases were men (60.4%) and 19 women (39.5%). The greater proportion of cases was found in the range from 26 to 35 years (39.5%). There was found tuberculous meningitis in 16 cases (33.3%), cryptoccocal meningitis in 20 cases (41.6%), cerebral toxoplasmosis in 6 cases (12.5%), viral meningoencephalitis in 4 cases (10.4%), and one neoplasic case. The prevalence of tuberculous meningoencephalitis was 33.3%. The sensitivity was 93,8 (71,7- 98,9), the specificity was 71,9 (84,5- 59,6) and the predictive values positive and negative were 62,5 (42.7-78.8) and 95,8 (79,8- 99,3) respectively, with a 95% of confidence value. The ROC Curve gave a 6.1 U/L as cut point with a sensitivity of 93,8% and a specificity of 71.9%, with an area under the curve of 89%.
Conclusion: The ADA test is a reliable test for the diagnosis of tuberculous meningoencephalitis in HIV patients.
Key words: sensitivity, specificity, predictive values, ADA test, HIV infection, tuberculosis / Tesis
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