Diagnostic Usefulness of Cytokine and Chemokine Levels in the Cerebrospinal Fluid of Patients with Suspected Tuberculous Meningitis

Ji-Soo Kwon Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;

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Joung Ha Park Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;

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Ji Yeun Kim Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;

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Hye Hee Cha Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;

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Min-Jae Kim Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;

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Yong Pil Chong Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;

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Sang-Oh Lee Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;

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Sang-Ho Choi Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;

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Yang Soo Kim Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;

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Jun Hee Woo Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;

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Yong Seo Koo Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

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Sang-Beom Jeon Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

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Sang-Ahm Lee Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

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Sung-Han Kim Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;

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In this study, we investigated the diagnostic utility of the cytokine profile of the cerebrospinal fluid (CSF) and enzyme-linked immunospot (ELISPOT) assays of patients with suspected tuberculous meningitis (TBM). We prospectively enrolled adult patients with suspected TBM, and CSF specimens were analyzed for 18 cytokines/chemokines and soluble programmed death protein 1 (PD-1) and programmed death ligand 1 (PD-L1). Enzyme-linked immunospot assays were performed on mononuclear cells from the CSF (CSF-MCs) and peripheral blood (PBMCs). A total of 87 patients with meningitis, including 42 TBM-suspected patients and 45 non-TBM patients, were enrolled. Excluding the 32 patients with possible TBM, 10 patients with TBM and 45 patients with non-TBM were finally analyzed. Levels of adenosine deaminase (ADA), interleukin 12 subunit β (IL-12p40), IL-13, macrophage inflammatory protein α (MIP-1α), and soluble PD-1 and PD-L1 in the CSF were significantly higher in the TBM group than in the non-TBM group (P < 0.05). The optimal cutoff values for the sensitivities and specificities of the test methods for diagnosing TBM with small samples of 10 cases of definite or probable TBM were as follows: ADA > 6.95 U/L, 70% and 81%; IL-12p40 > 52.04 pg/mL, 80% and 73%; IL-13 > 0.44 pg/mL, 90% and 47%; MIP-1α > 8.83 pg/mL, 80% and 62%; soluble PD-1 > 35.87 pg/mL, 80% and 63%; soluble PD-L1 > 24.19 pg/mL, 80% and 61%; CSF-MC ELISPOT > 13.5 spots/250,000 CSF-MC, 30% and 91%; and PBMC ELISPOT > 14 spots/250,000 PBMCs, 50% and 78%, respectively. Therefore, CSF IL-12p40, IL-13, MIP-1α, and soluble PD-1 and PD-L1 concentrations appear to be useful adjuncts for diagnosing TBM.

Author Notes

Address correspondence to Sung-Han Kim, Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, South Korea. E-mail: kimsunghanmd@hotmail.com

Financial support: This work was supported by grants from the National Research Foundation of Korea funded by the Ministry of Science, ICT and Future Planning (grant NRF-2018R1D1A1A09082099) and the Asan Institute for Life Sciences (2018-7040).

Authors’ addresses: Ji-Soo Kwon, Joung Ha Park, Ji Yeun Kim, Hye Hee Cha, Min-Jae Kim, Yong Pil Chong, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Jun Hee Woo, and Sung-Han Kim, Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, E-mails: kwonjs92@kaist.ac.kr, pjha89@hanmail.net, aeki22@snu.ac.kr, heyhe0102@naver.com, nahani99@gmail.com, drchong@amc.seoul.kr, soleemd@amc.seoul.kr, sangho@amc.seoul.kr, yskim@amc.seoul.kr, thanks1126@hanmail.net, and kimsunghanmd@hotmail.com. Yong-Seo Koo, Sang-Beom Jeon, and Sang-Ahm Lee, Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, E-mails: yo904@naver.com,sbjeonmd@gmail.com, and salee@amc.seoul.kr.

These authors contributed equally to this work.

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