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The Value of Detecting the Mycobacterial Antigens in Monocyte of the Cerebrospinal Fluid for the Diagnosis of Tuberculous Meningitis

Author: ChangXiaoLin
Tutor: ZhaoGang
School: Fourth Military Medical University
Course: Internal Medicine
Keywords: Tuberculous meningitis Cerebrospinal fluid Monocytes Mycobacterium tuberculosis antigen Purified protein derivative Early secretory antigenic target 6
CLC: R392
Type: Master's thesis
Year: 2008
Downloads: 151
Quote: 1
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Abstract


Due to the prevalence of multi-drug resistant tuberculosis, human immunodeficiency virus infection and poverty impact of a variety of factors, the incidence of TB was serious trend of increasing recovery, gradually increased the incidence of tuberculous meningitis (TBM). TBM is a serious infectious disease of the central nervous system, higher mortality and morbidity rates, early diagnosis, early treatment is the key to reducing mortality and morbidity. Yet a reliable and practical diagnostic methods to meet the needs of the clinical diagnosis. Mycobacterium tuberculosis (MTB) are intracellular parasites invade the body mainly parasites on the host cells of the monocyte-macrophage. Body infected with MTB vivo first appeared tuberculosis antigens, while tuberculosis antigen detection from host immune status. Therefore, this experiment For evaluation detected in cerebrospinal fluid (CSF) within the mononuclear cells tuberculosis antigen TBM diagnosis value, attempt to provide an effective method for the diagnosis of the TBM. In this experiment, the clinical diagnosis of 85 patients with infections of the central nervous system as the research object, using immunocytochemistry detected in CSF and peripheral blood (PB) monocytes tuberculin purified protein derivative (PPD) and early secretory antigenic target 6 (ESAT-6), and the application of epidemiological experiments and analysis methods to the widely recognized TBM clinical diagnostic criteria as the \non-MTB infection of the central nervous system of infected 40 patients), evaluation of the value of the detection of CSF and PB monocytes PPD and ESAT-6 antigen diagnosis of TBM. Results: 1. Detect CSF monocytes PPD antigen, TBM group 39 cases with positive staining control group of 10 patients with positive staining; 39 cases positive staining control group, six cases of positive detection ESAT-6 antigen, TBM group staining. 2. Detect of PB monocytes tuberculosis antigen, PPD and ESAT-6, the TBM group 11 patients had positive staining control group, no positive staining. Detection sensitivity of CSF mononuclear cells within the PPD antigen ESAT-6 antigen diagnosis of tuberculous meningitis are 86.7%, specificity of 87.5% and 92.5%, respectively. The sensitivity of detection of the the PB monocytes PPD antigen and the ESAT-6 antigen diagnosis of tuberculous meningitis was 24.4%, specificity was 100%. 5.TBM the group CSF and PB PPD, ESAT-6 percentage of positive cells were significantly higher than those in the control group (P lt; 0.001). 6.TBM group CSF PPD, ESAT-6-positive cells were significantly higher than the percentage of PB (P lt; 0.001). Conclusion: immunocytochemical methods to detect tuberculosis antigens in the CSF mononuclear cells within the sensitivity and specificity of the diagnosis of TBM compared with the ideal, and easy to carry, can be used for the diagnosis of TBM, should be widely applied. The lower the sensitivity of detection of the PB monocytes tuberculosis antigen diagnosis of TBM, is of limited value.

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