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The Utility of CSF Xpert MTB/RIF in Diagnosis of Tubercular Meningitis in Children

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Abstract

Objective

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.

Methods

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.

Results

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).

Conclusions

CSF GeneXpert is superior to smear for AFB in TBM.

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Acknowledgements

The authors thank the Director, Principal and Medical Superintendent, KIMS, Hubli.

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Authors and Affiliations

  1. Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubli, Karnataka, 580021, India

    Jyothy A., Vinod H. Ratageri, Shivanand Illalu, S. R. Fattepur & P. K. Wari

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  1. Jyothy A.
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  2. Vinod H. Ratageri
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  3. Shivanand Illalu
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  4. S. R. Fattepur
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  5. P. K. Wari
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Contributions

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.

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Correspondence to Vinod H. Ratageri.

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A., J., Ratageri, V.H., Illalu, S. et al. The Utility of CSF Xpert MTB/RIF in Diagnosis of Tubercular Meningitis in Children. Indian J Pediatr 86, 1089–1093 (2019). https://doi.org/10.1007/s12098-019-03032-0

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