No abstract

We read with interest the article "␤-trace protein test: New guidelines for the reliable diagnosis of cerebrospinal fluid fistula" by Meco et al, from the November 2003 issue of Otolaryngology-Head and Neck Surgery. The ␤TP test certainly will offer several diagnostic advantages over ␤2transferrin in that it is inexpensive, rapid, and potentially applicable to intra-operative use.The authors indicate nasal secretions can be collected at home and stored in a plastic tube for patients with intermittent cerebrospinal fluid leak. We wonder if the authors have serially studied nasal secretions to determine if CSF proteins undergo proteolysis after interacting with natural host defenses present in normal nasal secretions. Nasal mucus contains several proteolytic enzymes, and in patients with sinonasal infection, the offending bacteria may also effect proteolysis. 1 We know that transferrin proteins typically undergo some degree of breakdown upon interaction with lymphocytes and passive immune mediators. 2 Although the rate of proteolysis of ␤2-transferrin has not been studied, we believe proteolysis of CSF rhinorrhea may decrease sensitivity of this test. If ␤-trace protein-a prostaglandin synthase-is more stable than ␤2-transferrin, this may be another diagnostic advantage of the new test.Thank you,

No abstract

Quantitative measurement of betaTP is a noninvasive, highly sensitive, quick, and inexpensive method that can be used for the detection of CSF rhinorrhea in nasal secretions. However, in cases where there is doubt about the interpretation, the results should be proved with beta2-transferrin test or sodium-fluorescein test.

OBJECTIVE: Cerebrospinal fluid (CSF) fistulas need to be reliably diagnosed for the optimal management. Recently, in preference to β2-transferrin, another CSF protein, β-trace protein (βTP), is similarly used with a new method for CSF diagnosis. This study evaluates the sensitive interpretation and limits of this new βTP test for use in routine CSF fistula diagnosis. METHODS: Nephelometric detection of βTP has been made in nasal secretion, serum, and CSF samples from healthy individuals as well as patients with reduced glomerular filtration rate and with bacterial meningitis. Additionally, 53 patients with suspected CSF rhinorrhea are also analyzed. RESULTS: The βTP test can also be used to reliably diagnose CSF rhinorrhea even slightly better than the β2-transferrin test. It should not be used for patients with renal insufficiency and bacterial meningitis as they substantially increase serum and decrease CSF βTP values, respectively. CONCLUSION: Quantitative measurement of βTP is a noninvasive, highly sensitive, quick, and inexpensive method that can be used for the detection of CSF rhinorrhea in nasal secretions. However, in cases where there is doubt about the interpretation, the results should be proved with β2-transferrin test or sodium-fluorescein test.