RESUMO
OBJECTIVE: To evaluate diagnostic potential of three immunological tests, namely, detection of H37Rv antigen of M. Tuberculosis in CSF, detection of antibodies (IgG) against H37Rv in CSF and detection of antibodies (IgG) against H37Rv in serum for diagnosis of tuberculous meningitis in children. SUBJECTS: 50 children diagnosed as patients of tuberculous meningitis were included as cases and 48 children with CNS diseases of nontubercular etiology [pyogenic meningitis (n = 31), encephalitis (n = 10), seizure disorder of unknown etiology (n = 5), brain tumor (n = 2)] served as controls. METHODS: H37Rv antigen of M. tuberculosis was detected in CSF by Dot ELISA, and antibodies (IgG) against H37Rv in CSF and serum were detected by Plate ELISA. RESULTS: Detection of H37Rv antigen in CSF was the most sensitive (90%) and specific (95.83%) with positive and negative predictive values of 95.74% and 90.19%, respectively, followed by detection of antibodies in CSF (sensitivity-74%, specificity-89.58%, positive predictive value-88.10%, negative predictive value-76.78%). Detection of antibodies in serum had low sensitivity (50%), specificity (91.67%), positive predictive value (86.21%) and negative predictive value (63.76%). CONCLUSIONS: Detection of antigen in CSF is a rapid, sensitive and specific test for diagnosis of tuberculous meningitis in children. Detection of antibody in CSF may be useful in some cases but needs further evaluation. Detection of antibody in serum does not appear to be useful for diagnosis of tuberculous meningitis.
Assuntos
Antígenos de Bactérias/sangue , Antígenos de Bactérias/líquido cefalorraquidiano , Imunoglobulina G/sangue , Imunoglobulina G/líquido cefalorraquidiano , Mycobacterium tuberculosis/imunologia , Tuberculose Meníngea/sangue , Tuberculose Meníngea/líquido cefalorraquidiano , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Tuberculose Meníngea/microbiologiaRESUMO
Fourteen children with laboratory-confirmed Japanese encephalitis were given cranial computed tomographic (CT) scans six to 30 days after the onset of illness. The findings were variable; there was a generalized decrease in attenuation values, three patients showed features of cerebral atrophy, and four others had normal scans. The findings appeared to relate to both the severity and the stage of the illness at the time the scans were made. CT would appear to be of little use in making a specific diagnosis of Japanese encephalitis.
