Infection

, Volume 36, Issue 6, pp 597–600

Rapid Diagnosis of CNS Tuberculosis by a T-Cell Interferon-γ Release Assay on Cerebrospinal Fluid Mononuclear Cells

  • K. Kösters
  • R. Nau
  • A. Bossink
  • I. Greiffendorf
  • M. Jentsch
  • M. Ernst
  • S. Thijsen
  • T. Hinks
  • A. Lalvani
  • C. Lange
Case Report

Abstract

Central nervous system tuberculosis remains a clinical diagnostic challenge. The ex vivo Mycobacterium tuberculosis-specific enzyme-linked immunospot assay (ELISPOT) is a novel assay for the rapid detection of M. tuberculosis-specific T-lymphocytes in the peripheral blood. However, when performed on peripheral blood, this assay cannot distinguish between active tuberculosis or latent tuberculosis infection. On the assumption that M. tuberculosis-specific T-lymphocytes migrate to sites of infection, we were able to demonstrate high levels of M. tuberculosis-specific cells by ELISPOT in the cerebrospinal fluid of a patient with tuberculous meningitis and intracerebral tuberculoma four weeks before cerebrospinal fluid culture became positive for M. tuberculosis by culture.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Brodhun B, Altmann D, Haas W: Report on the epidemiology of tuberculosis for 2005. Robert-Koch-Institute, Berlin, 2006.Google Scholar
  2. 2.
    Menzies D, Pai M, Comstock G: Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med 2007; 146: 340–354.PubMedGoogle Scholar
  3. 3.
    Richeldi L: An update on the diagnosis of tuberculosis infection. Am J Respir Crit Care Med 2006; 174: 736–742.PubMedCrossRefGoogle Scholar
  4. 4.
    Yew WW, Leung CC: Update in tuberculosis 2006. Am J Respir Crit Care Med 2007; 175: 541–546.PubMedCrossRefGoogle Scholar
  5. 5.
    Chapman AL, Munkanta M, Wilkinson KA, Pathan AA, Ewer K, Ayles H, et al. Rapid detection of active and latent tuberculosis infection in HIV-positive individuals by enumeration of Mycobacterium tuberculosis-specific T cells. AIDS 2002; 16: 2285–2293.PubMedCrossRefGoogle Scholar
  6. 6.
    Gooding S, Chowdhury O, Hinks T, Richeldi L, Losi M, Ewer K, et al. Impact of a T cell-based blood test for tuberculosis infection on clinical decision-making in routine practice. J Infect 2007; 54: e169–e174.PubMedCrossRefGoogle Scholar
  7. 7.
    Ravn P, Munk ME, Andersen AB, Lundgren B, Nielsen LN, Lillebaek T, et al. Reactivation of tuberculosis during immuno- suppressive treatment in a patient with a positive QuantiFERON- RD1 test. Scand J Infect Dis 2004; 36: 499–501.PubMedCrossRefGoogle Scholar
  8. 8.
    Richeldi L, Luppi M, Losi M, Luppi F, Potenza L, Roversi P, et al. Diagnosis of occult tuberculosis in hematological malignancy by enumeration of antigen-specific T cells. Leukemia 2006; 20: 379–381.PubMedCrossRefGoogle Scholar
  9. 9.
    Richeldi L, Ewer K, Losi M, Hansell DM, Roversi P, Fabbri LM, et al. Early diagnosis of subclinical multidrug-resistant tuberculosis. Ann Intern Med 2004; 140: 709–713.PubMedGoogle Scholar
  10. 10.
    Strassburg A, Jafari C, Ernst M, Lange C: Rapid diagnosis of pulmonary tuberculosis by BAL-ELISPOT in an immunocompromised host. Eur Respir J 2008; 31: 1132–1135.PubMedCrossRefGoogle Scholar
  11. 11.
    Jafari C, Ernst M, Kalsdorf B, Greinert U, Diel R, Kirsten D, et al. Rapid diagnosis of smear-negative tuberculosis by bronchoalveolar lavage enzyme-linked immunospot. Am J Respir Crit Care Med 2006; 174: 1048–1054.PubMedCrossRefGoogle Scholar
  12. 12.
    Losi M, Bossink A, Codecasa L, Jafari C, Ernst M, Thijsen S et al. Use of a T-cell interferon-gamma release assay for the diagnosis of tuberculous pleurisy. Eur Respir J 270;30:1173–1179.doi: 10.1183/09031936.00067307.Google Scholar
  13. 13.
    Wilkinson KA, Wilkinson RJ, Pathan A, Ewer K, Prakash M, Klenerman P, et al. Ex vivo characterization of early secretory antigenic target 6-specific T cells at sites of active disease in pleural tuberculosis. Clin Infect Dis 2005; 40: 184–187.PubMedCrossRefGoogle Scholar
  14. 14.
    Pfyffer GE: Ranking of the polymerase chain reaction (PCR) and of other amplification methods in the diagnosis of tuberculosis. Pneumologie 2004; 58: 160–164.PubMedCrossRefGoogle Scholar
  15. 15.
    Jafari C, Bossink A, Goletti D, Codecasa L, Strassburg A, Greinert U et al (eds). Rapid diagnosis of smear-negative tuberculosis by bronchoalveolar lavage enzyme linked immunospot: interim analysis of a TBNET study. In: 17th European Respiratory Society (ERS) Annual Congress 2007, Stockholm.Google Scholar
  16. 16.
    Gopi A, Madhavan SM, Sharma SK, Sahn SA: Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest 2007; 131: 880–889.PubMedCrossRefGoogle Scholar
  17. 17.
    Nagesh BS, Sehgal S, Jindal SK, Arora SK: Evaluation of polymerase chain reaction for detection of Mycobacterium tuberculosis in pleural fluid. Chest 2001; 119: 1737–1741.PubMedCrossRefGoogle Scholar
  18. 18.
    Lange C, Hellmich B, Ernst M, Ehlers S: Rapid immunodiagnosis of tuberculosis in a woman receiving anti-TNF therapy. Nat Clin Pract Rheumatol 2007; 3: 528–534.PubMedCrossRefGoogle Scholar
  19. 19.
    Thwaites GE, Tran TH: Tuberculous meningitis: many questions, too few answers. Lancet Neurol 2005; 4: 160–170.PubMedGoogle Scholar
  20. 20.
    Kosters K, Nau R, Bossink A, Greiffendorf I, Jentsch M, Ernst M et al: Rapid diagnosis of CNS tuberculosis by a T-cell interferongamma release assay on cerebrospinal fluid mononuclear cells. Infection 2008; 36: 597–600.CrossRefGoogle Scholar
  21. 21.
    Thomas MM, Hinks TSC, Raghuraman S, Ramalingam N, Ernst M, Nau R, Lange C, Kösters K, Gnanamuthu C, John GT, Marshall B, Lalvani A: Rapid diagnosis of M. tuberculosis meningitis by enumeration of cerebrospinal fluid antigen-specific T-cells. Int J Tuberc Lung Dis 2008; 12: 1–7.Google Scholar
  22. 22.
    Biglino A, Crivelli PE, Concialdi E, Bolla C, Montrucchio G: Clinical usefulness of ELISPOT assay on pericardial fluid in a case of suspected tuberculous pericarditis. Infection 2008; 36: 601–604.CrossRefGoogle Scholar
  23. 23.
    Jafari C, Ernst M, Strassburg A, Greinert U, Kalsdorf B, Kirsten D, et al. Local immunodiagnosis of pulmonary tuberculosis by enzyme-linked immunospot. Eur Respir J 2008; 31: 261–265.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  • K. Kösters
    • 1
  • R. Nau
    • 2
  • A. Bossink
    • 3
  • I. Greiffendorf
    • 1
  • M. Jentsch
    • 1
  • M. Ernst
    • 4
  • S. Thijsen
    • 3
  • T. Hinks
    • 5
  • A. Lalvani
    • 5
  • C. Lange
    • 4
    • 6
  1. 1.Klinikum KrefeldKrefeldGermany
  2. 2.University Hospital of GöttingenGöttingenGermany
  3. 3.Diakonessenhuis UtrechtUtrechtThe Netherlands
  4. 4.Research Center BorstelBorstelGermany
  5. 5.Imperial CollegeLondonUK
  6. 6.Div. Clinical Infectious Diseases, Medical ClinicResearch Center BorstelBorstelGermany

Personalised recommendations