Utility of chloride and adenosine deaminase measurement in cerebrosphinal fluid for the early presumptive diagnosis of tuberculous meningitis

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dc.contributor.advisorWojno, Justyna Mariaen_ZA
dc.contributor.advisorOmar, Fierdozen_ZA
dc.contributor.authorSwanepoel, Hendréen_ZA
dc.date.accessioned2017-09-28T05:24:20Z
dc.date.available2017-09-28T05:24:20Z
dc.date.issued2017en_ZA
dc.description.abstractBackground: Chloride and adenosine deaminase measurements in cerebrospinal fluid are still sporadically requested as part of tuberculous meningitis work-up. In the literature, evidence is contradictory and opinion is divided on their utility in clinical practice. The accuracy of both for the early presumptive diagnosis of tuberculous meningitis was investigated in patients in a region with high prevalence of tuberculosis and HIV infection in order to inform a decision on whether to continue offering these tests to clinicians. Methods: A retrospective descriptive study of diagnostic accuracy was conducted at the National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa. Data were collected on all cerebrospinal fluid specimens submitted for tuberculosis culture between 1 January 2012 and 31 December 2014. Chloride and adenosine deaminase concentrations were compared with automated liquid culture for Mycobacterium tuberculosis as the reference standard. Findings: There were 2531 cerebrospinal fluid specimens submitted for tuberculosis culture during the study period; exclusion of duplicates yielded 2081 specimens. Chloride was requested on 711 (34·2%) specimens; 44 (6·2%) were tuberculosis culture-positive. Adenosine deaminase was requested on 152 (7·3%) specimens; 20 (13·2%) were culture-positive. Chloride sensitivity (<120 mmol/L) for the detection of tuberculous meningitis was 93·2% (95% confidence interval 81·3-98·6), with specificity 62·4% (58·6-66·1), positive predictive value 14% (10·3-18·6), negative predictive value 99·3% (97·9-99·9), positive likelihood ratio 2·48 (2·18-2·81), and negative likelihood ratio 0·109 (0·037-0·326). Adenosine deaminase sensitivity (>6 U/L) was 70% (45·7-88·1), specificity 89·4% (82·8-94·1), positive predictive value 50% (30·6-69·4), negative predictive value 95·2% (89·8-98·2), positive likelihood ratio 6·6 (3·72-11·7), and negative likelihood ratio 0·336 (0·171-0·657). Interpretation: In this patient population chloride and adenosine deaminase showed at best only modest performance as markers of tuberculous meningitis. However, very good negative predictive values could serve to identify patients highly unlikely to have the disease.en_ZA
dc.identifier.apacitationSwanepoel, H. (2017). <i>Utility of chloride and adenosine deaminase measurement in cerebrosphinal fluid for the early presumptive diagnosis of tuberculous meningitis</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Division of Chemical Pathology. Retrieved from http://hdl.handle.net/11427/25438en_ZA
dc.identifier.chicagocitationSwanepoel, Hendré. <i>"Utility of chloride and adenosine deaminase measurement in cerebrosphinal fluid for the early presumptive diagnosis of tuberculous meningitis."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Division of Chemical Pathology, 2017. http://hdl.handle.net/11427/25438en_ZA
dc.identifier.citationSwanepoel, H. 2017. Utility of chloride and adenosine deaminase measurement in cerebrosphinal fluid for the early presumptive diagnosis of tuberculous meningitis. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Swanepoel, Hendré AB - Background: Chloride and adenosine deaminase measurements in cerebrospinal fluid are still sporadically requested as part of tuberculous meningitis work-up. In the literature, evidence is contradictory and opinion is divided on their utility in clinical practice. The accuracy of both for the early presumptive diagnosis of tuberculous meningitis was investigated in patients in a region with high prevalence of tuberculosis and HIV infection in order to inform a decision on whether to continue offering these tests to clinicians. Methods: A retrospective descriptive study of diagnostic accuracy was conducted at the National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa. Data were collected on all cerebrospinal fluid specimens submitted for tuberculosis culture between 1 January 2012 and 31 December 2014. Chloride and adenosine deaminase concentrations were compared with automated liquid culture for Mycobacterium tuberculosis as the reference standard. Findings: There were 2531 cerebrospinal fluid specimens submitted for tuberculosis culture during the study period; exclusion of duplicates yielded 2081 specimens. Chloride was requested on 711 (34·2%) specimens; 44 (6·2%) were tuberculosis culture-positive. Adenosine deaminase was requested on 152 (7·3%) specimens; 20 (13·2%) were culture-positive. Chloride sensitivity (<120 mmol/L) for the detection of tuberculous meningitis was 93·2% (95% confidence interval 81·3-98·6), with specificity 62·4% (58·6-66·1), positive predictive value 14% (10·3-18·6), negative predictive value 99·3% (97·9-99·9), positive likelihood ratio 2·48 (2·18-2·81), and negative likelihood ratio 0·109 (0·037-0·326). Adenosine deaminase sensitivity (>6 U/L) was 70% (45·7-88·1), specificity 89·4% (82·8-94·1), positive predictive value 50% (30·6-69·4), negative predictive value 95·2% (89·8-98·2), positive likelihood ratio 6·6 (3·72-11·7), and negative likelihood ratio 0·336 (0·171-0·657). Interpretation: In this patient population chloride and adenosine deaminase showed at best only modest performance as markers of tuberculous meningitis. However, very good negative predictive values could serve to identify patients highly unlikely to have the disease. DA - 2017 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - Utility of chloride and adenosine deaminase measurement in cerebrosphinal fluid for the early presumptive diagnosis of tuberculous meningitis TI - Utility of chloride and adenosine deaminase measurement in cerebrosphinal fluid for the early presumptive diagnosis of tuberculous meningitis UR - http://hdl.handle.net/11427/25438 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/25438
dc.identifier.vancouvercitationSwanepoel H. Utility of chloride and adenosine deaminase measurement in cerebrosphinal fluid for the early presumptive diagnosis of tuberculous meningitis. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Division of Chemical Pathology, 2017 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/25438en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDivision of Chemical Pathologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherClinical Pathologyen_ZA
dc.titleUtility of chloride and adenosine deaminase measurement in cerebrosphinal fluid for the early presumptive diagnosis of tuberculous meningitisen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMeden_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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