Diagnostic utility of estimation of mycobacterial antigen A60 specific immunoglobulins in serum and CSF in adult neurotuberculosis.

An ELISA assay based on mycobacterial antigen A60 (Anda, Biologicals France) was used to detect specific immunoglobulins (IgM, IgA and IgG) in 48 cases of adult neurotuberculosis (24 TBM; 24 Tuberculoma) and in 48 controls (24 diseased controls; 24 healthy controls). Serum was analysed in all the subjects whereas CSF was assayed only in TBM cases and diseased controls. The cut off values used for IgM, IgG and IgA in this study were 1.500 ODI (optical density index) at 1:100 dil, 250 units/ml and 150units/ml respectively in serum; and 1.500 ODI at 1:10 dil, 10 units/ml and 10 units/ml respectively in CSF. The mean titres of all three antibodies were found to be significantly higher in cases as compared to controls. In cases of TBM, in serum, the percentage positivity for IgM, IgG, IgA and combination of IgG or IgA were 41.67, 87.50 87.50 and 95.83 respectively. The corresponding figures in CSF were 62.50, 75.0, 66.67 and 79.16 for IgM, IgG, IgA and 'IgA or IgM' respectively. In tuberculoma cases, in serum, the figures were 37.50, 75.0, 75.0 and 83.33 respectively. Overall, a high sensitivity and specificity were obtained in cases of TBM (Serum: ST = 95.83%: SP = 87.50%; CSF ST = 79.16%. SP = 100%) and Tuberculoma cases (serum: ST = 83.33% SP = 87.50%) employing the combined antibody estimations.

Usefulness of ELISA using antigen A60 in serodiagnosis of neurotuberculosis.

Anti-mycobacterial antibody to A60 antigen were quantified in the sera and cerebrospinal fluid (csf) samples of one hundred patients of neurotuberculosis and twenty non-tubercular controls by immunoenzymatic (ELISA) assay. Sixty three patients (63%) had "significant" antibody titres in serum and/or CSF samples. In contrast, none of the samples from the control group showed this level of antibody concentration. The evaluation of this assay in tuberculoma (group A, 79 cases) vis-a-vis tubercular meningitis or TBM (group B, 21 patients) revealed significant antibody levels in the former 46 (58.2%) in comparison to 17 (77.3%) in the latter group. A positive relationship was observed in the titres of anti-mycobacterial antibodies in serum and in CSF both in cases of tuberculoma and TBM. This study indicates the utility of A60 antigen ELISA assay in categorising these patients into tubercular aetiology specially in the absence of bacteriological isolation from CSF which still remains the gold standard diagnostic criterion.