The Utility of CSF Xpert MTB/RIF in Diagnosis of Tubercular Meningitis in Children
- 68 Downloads
To determine the utility of CSF Xpert MTB/RIF (GeneXpert) in diagnosis of tubercular meningitis in children in the age group of 2 mo to 12 y.
This hospital based prospective observational study was conducted at Department of Pediatrics, Karnataka Institute of Medical Sciences (KIMS), Hubli from December 2015 through November 2016. All children with clinically suspected tuberculous meningitis (TBM) were included in the study. These children underwent a detailed history taking, clinical examination, blood investigations, lumbar puncture and CT brain. Cerebrospinal fluid (CSF) samples were sent for CSF GeneXpert examination. Statistical analysis was done using IBM SPSS Statistics Version 20.
A total of 28 children were enrolled in the study. Six (21.4%), 4 (14.3%) and 18 (64.3%) cases were definite, probable and possible TBM cases respectively. Most common age group affected was <5 y (83.33%) with median age 2.5 y (IQR 4.875). Male:female ratio was 1.5:1. CSF GeneXpert was tested positive in 6 cases (21.4%). The sensitivity of the test against the clinical scoring (>/=10) was 46.15% (95% CI, 19.22–74.87) and specificity was 100% (95% CI, 78.20–100). There was a significant association between CSF GeneXpert and Mantoux test (P = 0.002), CSF cell type >50% lymphocytes (P = 0.005) and CSF protein >100 mg/dl (P = 0.025) along with CT hydrocephalus (P = 0.021), granuloma (P = 0.009) and basal exudates (P = 0.025). None of the cases were tested smear positive for acid-fast bacilli (AFB).
CSF GeneXpert is superior to smear for AFB in TBM.
KeywordsCSF Xpert MTB/RIF TBM Clinical score Children
The authors thank the Director, Principal and Medical Superintendent, KIMS, Hubli.
JA: Designed the study, collected the materials and wrote the manuscript; VHR: Helped in designing the study, writing the manuscript; SRF and SI: Reviewed the literature and helped in managing the cases; PKW: Reviewed the literature and helped in manuscript writing. VHR is the guarantor for this article.
Compliance with Ethical Standards
Conflict of Interest
- 1.WHO. WHO Global tuberculosis report 2016 [Internet]. 2016. Available at: http://www.who.int/tb/publications/global_report/en/. Accessed 14 Jan 2018.
- 2.RNTCP (DGHS), TB India 2016 by RNTCP Annual Report. Available at: https://www.tbcindia.gov.in/showfile.php?lid=3180. Accessed 10 Dec 2018.
- 4.Sarah JG, Martin AE. Tuberculosis and fungal and parasitic infections of cental nervous system. In: Albright AL, Pollack IF, Adelson PD, editors. Principles and Practice of Pediatric Neurosurgery, 2nd ed. New York: Thieme Medical Publishers; 2013. p. 1182–96.Google Scholar
- 7.World Health Organization. Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children: policy update. World Health Organization (2013). Available at: http://www.who.int/iris/handle/10665/112472. Accessed 14 Jan 2019.
- 10.Alvarez-Uria G, Azcona JM, Midde M, Naik PK, Reddy S, Reddy R. Rapid diagnosis of pulmonary and extrapulmonary tuberculosis in HIV-infected patients. Comparison of LED fluorescent microscopy and the GeneXpert MTB/RIF assay in a district hospital in India. Tuberc Res Treat. 2012;1–4.Article ID: 932862.Google Scholar