To the Editor: Tubercular meningitis accounts for about 5% of all cases of tuberculosis, which occurs mostly due to hematogenous spread of tubercular bacilli to meninges and cerebrospinal fluid (CSF) [1]. Leucine rich alpha 2 glycoprotein (LRG) is a newer protein molecule that has been discovered to play an important role in the pathogenesis of meningitis [2, 3].

We conducted a prospective case control study among children aged less than 18 y with CBNAAT positive tubercular meningitis, who were admitted in pediatric ward from October 2020 to October 2022 after approval of Institute Ethics committee. A total of 110 children were taken for the study, out of which 90 were cases and 20 were controls with febrile seizure or meningismus. Their CSF was centrifuged and stored at -80 ℃ and LRG ELISA Kit was used to detect LRG value in the stored CSF samples. Comparison was made among survivors, non-survivors and controls.

The LRG level (ng/ml) in children with tubercular meningitis was 217.09 ± 39.52 ng/mL, significantly higher than the control group with a mean of 88.57 ± 7.91 ng/mL (p <0.001). Non-survivors exhibited a higher mean LRG level of 259.01 ± 20.10 ng/mL compared to survivor’s mean LRG level of 192.82 ± 24.8 ng/mL (p <0.001). These findings resonate with prior research efforts. LRG as potential biomarker was reported in bacterial meningitis by Chong et al. [2]. Fujimoto et al. reported LRG as a potential biomarker in the diagnosis of active pulmonary tuberculosis [4]. The findings of this research work showed a significant increase in LRG level in CSF of tubercular meningitis patients with a positive correlation with disease severity. The remarkable sensitivity, specificity and predictive values underscore the clinical significance of LRG in disease management. These outcomes lay the groundwork for further research and potential clinical applications in the management of tubercular meningitis.