Detection of Mycoplasma pneumoniae in cerebrospinal fluid of children: Quantification of CSF-IgG antibody

S, Noorbakhsh; M, Shekarabi; Z, Kalbasi; A, Tabatabaei; H, Tonekaboni; L, Afsharkhas; M, Vafaei-shahi

Volume 68, Issue 5 (6 2010) Tehran Univ Med J 2010, 68(5): 274-280 | Back to browse issues page

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S N, M S, Z K, A T, H T, L A et al . Detection of Mycoplasma pneumoniae in cerebrospinal fluid of children: Quantification of CSF-IgG antibody. Tehran Univ Med J 2010; 68 (5) :274-280
URL: http://tumj.tums.ac.ir/article-1-340-en.html

Detection of Mycoplasma pneumoniae in cerebrospinal fluid of children: Quantification of CSF-IgG antibody

Noorbakhsh S ^*

¹, Shekarabi M

, Kalbasi Z

1- , samileh_noorbakhsh@yahoo.com

Abstract: (6776 Views)

Background: M. pneumoniae infection in children is usual and diagnosis of its neurologic complications for rapid treatment is very important. To compare the CSF- M. pneumoniae antibody level between febrile children with acute neurologic signs (Menigoencephalitis, Guillan Barre Syndrome (GBS), Transverse myelitis, Ataxia and so on) with unaffected ones.

Methods: A cross sectional/ case control study in pediatric wards of Rasoul-e-Akram & Mofid hospitals (2007-2009) was done. The amount of Specific M. pneumoniae IgG (ELISA) antibody level determined in CSF of 55 cases and in 10 controls. Chi square values (CI 95%, p< 0.05) calculated for all categorical variables. Sensitivity specificity Positive Predictive Value (PPV) Negative Predictive Value (NPV) of CSF antibody level determined by using the Area under the ROC Curve.

Results: Cases (n= 55) aged between five month to 13 years with mean age of 3.84±3.43 years. Area Under Curve (AUC) in ROC was 0.876 (%95 CI, 0.78- 0.96 p< 0.0001). Cut off level for antibody was 0.0025 with 73% sensitivity 90% specificity 100% PPV 28.8% NPV. CSF antibody level had significant difference between cases and controls [0.08± 0.26 Versus 0.001± 0.001 p: 0.02] It had poor agreement between cases and controls (Kappa= 0.27). Lowest amount seen in cases with aseptic meningitis highest amount observed in cases with GBS and cases with focal neurologic signs.

Conclusion: The presence of very low amount (0.0025) of M. pneumoniae antibody in CSF of febrile children with acute neurologic signs had 70% sensitivity and 90% specificity 100% PPV but had low (28.8%) NPV. M. pneumoniae would be a rare cause in cases with aseptic meningitis. Finding the M. pneumoniae-DNAs in CSF are not so frequent (2%) but in high suspicious cases adding this test to determining the CSF antibody level might be helpful.

Keywords: Mycoplasma pneumoniae, antibody, IgG, ELISA, meningoencephalitis, Cerebrospinal Fluid (CSF)

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