IgM quantification in the cerebrospinal fluid of sleeping sickness patients by a latex card agglutination test

V Lejon, D Legros, M Richer, JA Ruiz… - Tropical Medicine & …, 2002 - Wiley Online Library
V Lejon, D Legros, M Richer, JA Ruiz, V Jamonneau, P Truc, F Doua, N Djé, FX N'Siesi…
Tropical Medicine & International Health, 2002Wiley Online Library
An increased IgM concentration in cerebrospinal fluid (CSF), occurring as a consequence of
massive intrathecal IgM synthesis, is a marker of interest for diagnosis of the meningo‐
encephalitic stage in human African trypanosomiasis. However, in current practice, IgM in
CSF is not determined because of the lack of a simple and robust test that is applicable in
African rural regions where the disease prevails. We describe the development of a
sensitive semiquantitative card agglutination test, LATEX/IgM, for IgM quantification in CSF …
An increased IgM concentration in cerebrospinal fluid (CSF), occurring as a consequence of massive intrathecal IgM synthesis, is a marker of interest for diagnosis of the meningo‐encephalitic stage in human African trypanosomiasis. However, in current practice, IgM in CSF is not determined because of the lack of a simple and robust test that is applicable in African rural regions where the disease prevails. We describe the development of a sensitive semiquantitative card agglutination test, LATEX/IgM, for IgM quantification in CSF. The test is simple and fast and the lyophilized reagent remains stable even at 45 °C. CSF end‐titres obtained with LATEX/IgM parallel the IgM concentrations determined by nephelometry and enzyme‐linked immunosorbent assay. Detection of intrathecal IgM synthesis is the most sensitive marker for CNS involvement in sleeping sickness. At a cut‐off value of ≥ 8, the sensitivity and specificity of LATEX/IgM for intrathecal IgM synthesis are 89.4 and 92.7%. As a consequence, patients with LATEX/IgM end‐titres ≥ 8 are likely to have intrathecal IgM synthesis, thus central nervous system involvement and therefore should be treated accordingly. Further studies should concentrate on the relationship between the LATEX/IgM end‐titres, presence of intrathecal IgM synthesis and occurrence of treatment failures in patients treated with pentamidine.
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