Diagnostic Value of the Leukocyte Esterase Test for Early Detection of Pleocytosis in Cerebrospinal Fluid of Patients with Suspected Acute Bacterial Meningitis.

BACKGROUND: Rapid and accurate diagnosis of patients with suspected bacterial meningitis (BM) is crucial to prevent potential subsequent mortality and morbidity. The aim of this study was to explore the diagnostic value of the rapid leukocyte esterase (LE) strip test in identifying pleocytosis in cerebrospinal fluid (CSF) samples of patients with suspected BM. METHODS: A total of 126 patients with suspected meningitis were enrolled in this prospective study. Microscopic examination (cell count and differential) and leukocyte esterase (LE) rapid strip test were performed on cerebrospinal fluid (CSF) samples. Sensitivity, specificity, positive predictive value and negative predictive value of the LE test were determined. RESULTS: Fifty-two patients (41%) had pleocytosis in the CSF, while 48 (38%) patients had a positive rapid LE strip test result. The diagnostic accuracy of this test for pleocytosis was translated to a sensitivity of 84.6% (95%CI 71.9, 93.1) and a specificity of 94.5% (95%CI 86.7, 98.5), with an area under the receiver operating curve of 0.88. CONCLUSION: The LE strip test, through rapid and accurate determination of CSF pleocytosis, could be considered as an additional test in the diagnosis of bacterial meningitis. It can be tested at bedside and is feasible to do in resource-limited settings.

Cholesterol esterase activity in cerebrospinal fluid of multiple sclerosis patients.

Previous studies of brain tissue from multiple sclerosis (MS) patients have shown that the amount of cholesterol esters increases and the level of cholesterol esterase (ChE) activity decreases compared to controls. In this study we present a simple method for measuring ChE activity at pH 7.2 in cerebrospinal fluid (CSF) and CSF-ChE activity during the 18-month follow-up of 32 MS patients in remitting, remitting and relapsing, and chronic progressive courses of the disease. ChE activity in the MS group was compared to the enzyme activity in the CSF of 52 controls and 17 patients suffering from other organic neurological diseases. In the relapse group, ChE activity decreased significantly compared to the chronic progressive group (P less than 0.05) and controls (P less than 0.001). ChE activity was correlated with the Kurtzke points of functional status only in the chronic progressive group of MS patients (P less than 0.05, r = 0.569). During the 18-month follow-up, no significant change was seen in individual levels of ChE among the MS patients. It was concluded that the decrease in pH 7.2 ChE activity in the CSF during the acute phase of MS may reflect the decreased ChE activity in the brains of MS patients. However, the large interindividual variation within patient groups and the slow change at different stages of the disease indicate that measurement of ChE activity in CSF is not suitable for evaluating the clinical diagnosis of MS or for follow-up of the activity of the disease.

Evidence for two cholesterol ester hydrolases in human cerebrospinal fluid.

In the present study, the properties, such as pH optima, detergent requirement, and effects of various lipids, of cholesterol ester hydrolase in human cerebrospinal fluid (CSF) were examined, and the activity levels of the enzyme in CSF from multiple sclerosis (MS) patients and non-MS individuals were compared. Our data indicate that the enzyme in CSF exhibits two pH optima: pH 6.0 in the presence of Triton X-100 and pH 7.0 in the presence of sodium taurocholate. Both phosphatidylethanolamine (PE) and phosphatidylserine (PS) enhanced the hydrolase activity at pH 6.0. The activity at pH 7.0, on the other hand, was enhanced slightly in the presence of PE but was inhibited in the presence of PS. These data suggest the presence of two cholesterol ester hydrolases in CSF and also indicate that the activity at pH 6.0 may be due to microsomal enzyme in brain and that at pH 7.0 may be due to myelin enzyme. The hydrolase activity at pH 7.0 was significantly lower in CSF from MS patients. The activity at pH 6.0 in CSF from MS and non-MS patients, however, did not differ significantly. This indicates that the reduction in pH 7.0 hydrolase activity in CSF may be related to demyelination.