Avoid common mistakes on your manuscript.
To the Editor: The scientific letter entitled “Cerebrospinal fluid leucine rich alpha-2 glycoprotein in children with tubercular meningitis with their diagnostic and prognostic significance: a prospective study” published recently in IJP [1] and answer of pertinent questions raised by Dr. Josef Finsterer [2] are mentioned below.
Leucine rich alpha-2 glycoprotein (LRG) is an acute phase protein and its expression is up regulated by the mediators of the acute phase response. The elevation in cerebrospinal fluid of leucine rich alpha-2 glycoprotein is directly related to degree of severity of damage of neural tissue as observed in this study including work done earlier in acute bacterial meningitis and tuberculous meningitis with very high sensitivity and specificity. In acute bacterial meningitis, the sensitivity, specificity, PPV and NPV is 96%, 75%, 92.3% and 85.7%, respectively in differentiating bacterial from aseptic meningitis [3, 4]. Therefore, it serves as a biomarker of not only tuberculous meningitis but also other types of meningitis.
Its expression is also enhanced in children with hydrocephalus and intracranial hemorrhage including extradural hemorrhage and is related to severity of damage of neural tissues [5].
We do agree with the limitation of number of controls i.e. children of febrile seizure with definite indication of lumbar puncture and normal cytochemical study. It is unethical to go for lumbar puncture in normal children. Therefore our control size is less as compared to cases.
References
Prasad R, Verma H, Srivastava R, Aishwarya, Kumar A. Cerebrospinal fluid leucine rich alpha-2 glycoprotein in children with tubercular meningitis with their diagnostic and prognostic significance: a prospective study. Indian J Pediatr. 2023. https://doi.org/10.1007/s12098-023-04869-2.
Finsterer J. Cerebrospinal fluid leucine rich alpha-2 glycoprotein in children with tubercular meningitis with their diagnostic and prognostic significance: a prospective study: Correspondence. Indian J Pediatr. 2024. https://doi.org/10.1007/s12098-024-05022-3.
Talukder K, Prasad R, Abhinay A, et al. Cerebrospinal fluid leucine rich alpha-2 glycoprotein (LRG) levels in children with acute bacterial meningitis. Indian J Pediatr. 2022;89:192–4.
Fujimoto M, Matsumoto T, Serada S, et al. Leucine-rich alpha 2 glycoprotein is a new marker for active disease of tuberculosis. Sci Rep. 2020;10:3384.
Ma D, Ma L, Zhao Y, Li Y, Ye W, Li X. The LRG-TGF-β-Alk-1/TGFßRII-Smads as predictive biomarkers of chronic hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurol Surg A Cent Eur Neurosurg. 2023. https://doi.org/10.1055/s-0043-1771277.
Funding
Funded by Indian Journal of Pediatrics Grant 2021 for conducting post graduate MD thesis in India.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Prasad, R., Verma, H., Srivastava, R. et al. Cerebrospinal Fluid Leucine Rich Alpha-2 Glycoprotein in Children with Tubercular Meningitis with their Diagnostic and Prognostic Significance: A Prospective Study: Authors’ Reply. Indian J Pediatr 91, 529 (2024). https://doi.org/10.1007/s12098-024-05023-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-024-05023-2