Comparison of gel-based methods for the detection of cerebrospinal fluid rhinorrhea

Cerebrospinal fluid (CSF) rhinorrhea is a serious condition that may result in severe complications. Various laboratory tests, relying on the detection of CSF-specific proteins in nasal secretions, have been developed but diagnosis remains challenging. The aim of this study was to evaluate two new methods targeting either beta 2-transferrin or beta-trace-protein. Rhinorrhea samples horn patients suspected of CSF leakage (n = 36) were analyzed using two-dimensional gel electrophoresis (2-DE) for CSF rhinorrhea diagnosis. Twelve patients with rhinorrhea strongly suggestive of a CSF leak also underwent a fluorescein test. The same cohort was retrospectively analyzed with a beta-trace protein immunoblot developed in-house (n = 36) and a new commercial beta 2-transferrin immunofixation assay (Sebia, Evry, France) (n = 33). 2-DE was positive in 9 patients suffering from rhinorrhea following skull base fracture (n = 3), post-surgery (n = 4), or spontaneously (n = 2). The 27 remaining cases were negative. These results were confirmed by the beta-trace protein immunoblot and beta 2-transferrin immunofixation tests, except for one sample found negative with 2-DE but positive with the two other assays. Results from the three analytical methods were concordant with fluorescein tests. Beta-trace protein immunoblot and beta 2-transferrin immunofixation assays are fast and reliable methods that allow detecting CSF leakage in nasal fluid with high sensitivity and specificity. (C) 2012 Elsevier B.V. All rights reserved.