[Allergic pseudorheumatic and infarctive responses in hematologic dissemination of tuberculosis].
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Early diagnosis of neurotuberculosis (NTB), useful in prevention of mortality and morbidity, remains a challenge despite availability of several tests. An ELISA test to detect IgG and IgM antibodies against Mycobacterial antigen A-60 (Anda Biologicals, France) was done in 677 specimens; group 1 (NTB): 373 sera and 167 cerebrospinal fluid (CSF), group 2: 100 sera from healthy subjects, group 3: 17 CSF from patients undergoing neurosurgical operations for non-tubercular diseases. Anti-A 60 IgA estimation was done in 99 sera from group 1 and all 100 from group 2. Working dilutions were 1:200 for serum and 1:10 for CSF. Serum IgM and IgG anti-A 60 antibodies were more often detected in group 1 than in 2 (50% Vs 10%, p<.001). Anti-IgG and IgM antibody were detected more often in group 1 than in group 3 (33% Vs 6%, p<.001). In serum and CSF both IgM positivity was more than IgG in 2 subgroups of NTB and these are tubercular meningitis, spinal tuberculosis whereas in tuberculoma IgG positivity was more as compared to other 2 groups. Sera were more often positive than CSF (50% Vs 33%, p<.001). Of 32 patients, in whom magnetic resonance imaging (MRI) was done, 15/18 (83%) patients with suggestive findings in MRI had a positive ELISA (IgG or IgM). AntiA-60 antibody is a useful aid in the diagnosis of NTB, especially in smear and culture negative NTB where one does not have much diagnostic opportunities to choose from.
A method for detection of antituberculous antibodies by enzyme immunoassay system developed by the authors, was tested on 317 blood serum samples taken from patients with tuberculosis and non-tuberculous diseases of the lungs, vertebral column, kidneys and genitalia. Depending on the process site, the detection rate of specific antibodies and their specificity made up 57-77% and 85-95%, respectively, which practically agrees with the data produced as a result of a simultaneously conduction of three routine serologic reactions.
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Extra pulmonary tuberculosis are frequent in Africa and have a special severity due to delayed diagnosis and multifocal forms. Various punctures and biopsies may be necessary to demonstate the tuberculous infection. Even with modern treatment it too often implies important risks of severe sequelae.