19 Ago Intracellular staining of Cerebral Spinal Fluid as an adjunctive tool for an early diagnosis of tuberculous meningitis 

Background: Pediatric tuberculous meningitis is a highly morbid, often fatal disease. Its prompt diagnosis and treatment saves lives, in fact delays in the initiation of therapy have been associated with high mortality rates.
Case presentation: This is a case of an Italian child who was diagnosed with tuberculous meningitis after a history of a month of headache, fatigue and weight loss. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis with predominance and decreased glucose concentration. Microscopy and conventional diagnostic tests to identify Mycobacterium tuberculosis were negative, while a non classical method based on intracellular cytokine flow cytometry response of CD4 cells in cerebral spinal fluid helped us to address the diagnosis, that was subsequently confirmed by a nested Polymerase Chain Reaction amplifying a 123 base pair fragment of the M. tuberculosis DNA.

Conclusions: We diagnosed tuberculous meningitis at an early stage through an innovative immunological approach, supported by a nested Polymerase Chain Reaction for detection of M. tuberculosis DNA. An early diagnosis is required in order to promptly initiate a therapy and to increase the patient’s survival.