{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T09:44:51Z","timestamp":1765705491823,"version":"3.48.0"},"reference-count":12,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"accepted":{"date-parts":[[2020,4,4]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Tuberculous meningitis (TBM) is a severe infection which may lead to serious complication and mortality. Prompt diagnosis and treatment are essential. There is a need for a simple and fast laboratory test to differentiate TBM from other causes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Retrospective review was conducted for cerebrospinal fluid adenosine deaminase (CSF-ADA) activity which was measured at the Chemical Pathology Laboratory of Princess Margaret Hospital, the sole centre providing such service in Hong Kong, for 51 patients with suspected meningitis from nine local hospitals between June 2014 and July 2017. TBM diagnosis was defined by positive culture and\/or nucleic acid amplification test result of\n                      <jats:italic>Mycobacterium tuberculosis<\/jats:italic>\n                      complex in CSF.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CSF-ADA activity was significantly higher in the TBM group (8.6\u00b12.1\u2009IU\/L, n=8) than that of the non-TBM group (2.8\u00b15.9\u2009IU\/L, n=43). The optimal clinical cut-off of 5.1\u2009U\/L for TBM diagnosis in our laboratory yielded 100% sensitivity, 91% specificity, positive likelihood ratio of 10.8 and negative likelihood ratio of 0. In rare circumstance, false elevation may be seen in non-tuberculous cause, such as central nervous system lymphoma and fungal infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We recommend the use of CSF-ADA activity, which is a simple, fast and robust test for early differentiation of TBM from other causes, to facilitate timely initiation of antituberculous treatment and potentially improve patients\u2019 outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jclinpath-2019-206397","type":"journal-article","created":{"date-parts":[[2020,5,18]],"date-time":"2020-05-18T17:19:19Z","timestamp":1589822359000},"page":"800-802","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Determination of cerebrospinal fluid adenosine deaminase activity cut-off for the diagnosis of tuberculous meningitis in Hong Kong"],"prefix":"10.1136","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9099-4720","authenticated-orcid":false,"given":"Toby Chun Hei","family":"Chan","sequence":"first","affiliation":[{"name":"Chemical Pathology Laboratory, Department of Pathology, Hong Kong Children's Hospital, Kowloon, Hong Kong"},{"name":"Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Kowloon, Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0767-3163","authenticated-orcid":false,"given":"Sammy Pak Lam","family":"Chen","sequence":"additional","affiliation":[{"name":"Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Kowloon, Hong Kong"},{"name":"Chemical Pathology Laboratory, Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chloe Miu","family":"Mak","sequence":"additional","affiliation":[{"name":"Chemical Pathology Laboratory, Department of Pathology, Hong Kong Children's Hospital, Kowloon, Hong Kong"},{"name":"Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Kowloon, Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chor Kwan","family":"Ching","sequence":"additional","affiliation":[{"name":"Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Kowloon, Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristine Shik","family":"Luk","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, Department of Pathology, Princess Margaret Hospital, Kowloon, Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yat Ming","family":"Tsang","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, Department of Pathology, Princess Margaret Hospital, Kowloon, Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel Cheuk Wa","family":"Leung","sequence":"additional","affiliation":[{"name":"Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Kowloon, Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,5,18]]},"reference":[{"key":"2025121401394447000_73.12.800.1","unstructured":"Tuberculosis and Chest Service DoH, the Government of the HOng Kong Special Adminstrative Region . Annual report 2016 Tuberculosis & Chest Service of the,Department of Health 2016."},{"key":"2025121401394447000_73.12.800.2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw778"},{"key":"2025121401394447000_73.12.800.3","first-page":"1391","article-title":"A Registry of tuberculous meningitis in Hong Kong","volume":"9","author":"Lau","year":"2005","journal-title":"Int J Tuberc Lung Dis"},{"key":"2025121401394447000_73.12.800.4","first-page":"1382","article-title":"Diagnostic value of adenosine deaminase in cerebrospinal fluid for tuberculous meningitis: a meta-analysis","volume":"14","author":"Xu","year":"2010","journal-title":"Int J Tuberc Lung Dis"},{"key":"2025121401394447000_73.12.800.5","doi-asserted-by":"publisher","DOI":"10.3109\/00365540903428158"},{"key":"2025121401394447000_73.12.800.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2017.02.012"},{"key":"2025121401394447000_73.12.800.7","first-page":"OC22","article-title":"Determination and validation of a lower cut off value of cerebrospinal fluid adenosine deaminase (CSF-ADA) activity in diagnosis of tuberculous meningitis","volume":"11","author":"Henry","year":"2017","journal-title":"J Clin Diagn Res"},{"key":"2025121401394447000_73.12.800.8","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2221-3"},{"key":"2025121401394447000_73.12.800.9","first-page":"RA215","article-title":"Pathogenesis, diagnosis, treatment, and outcome aspects of cerebral tuberculosis","volume":"10","author":"Katti","year":"2004","journal-title":"Med Sci Monit"},{"key":"2025121401394447000_73.12.800.10","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-004-1110-z"},{"key":"2025121401394447000_73.12.800.11","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/158.4.896"},{"key":"2025121401394447000_73.12.800.12","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/20.3.525"}],"container-title":["Journal of Clinical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jclinpath-2019-206397","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T09:39:52Z","timestamp":1765705192000},"score":1,"resource":{"primary":{"URL":"https:\/\/jcp.bmj.com\/lookup\/doi\/10.1136\/jclinpath-2019-206397"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,18]]},"references-count":12,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,11,19]]},"published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1136\/jclinpath-2019-206397"],"URL":"https:\/\/doi.org\/10.1136\/jclinpath-2019-206397","relation":{},"ISSN":["0021-9746","1472-4146"],"issn-type":[{"type":"print","value":"0021-9746"},{"type":"electronic","value":"1472-4146"}],"subject":[],"published":{"date-parts":[[2020,5,18]]}}}