RAPID CONFIRMATION OF TUBERCULOUS MENINGITIS IN CHILDREN BY LIQUID CULTURE MEDIA
AbstractBackground: Tuberculous meningitis (TBM) is an important and serious complication of tuberculosis(TB) related to high morbidity and mortality. Childhood TBM is a diagnostic dilemma as the clinicalfeatures are non-specific and cerebrospinal fluid (CSF) mycobacterial count is low. The diagnosis ismade mostly on clinical grounds, CSF analysis and radiological findings and treatment is initiatedbefore the culture results arrive. These non-specific rapid diagnostic tools may be misleading resultingin over diagnosis or misdiagnosis. The conventional way of establishing a definitive diagnosis of TBMis by solid-medium culture that requires 4–7 weeks which may often lead to injudicious exposure tohazards associated with anti-tuberculous therapy (ATT). Methods: This study was carried out at theMicrobiology department of University Of Health Sciences Lahore. The aim of this study was to assessthe reliability of clinical features and CSF analysis in diagnosing childhood TBM by utilizing BACTECMycobacterial Growth Indicator Tube (MGIT) 960 system as a rapid confirmatory tool. It was anobservational study that included 100 CSF samples from suspected paediatric TBM cases. Aftercarrying out the biochemical and cytological analysis the samples were subjected to Ziehl-Neelsen(ZN) staining and inoculated onto MGIT 960 system. The culture growths were tested for sensitivity tofirst line ATT. Results: Of the 100 samples inoculated, only 14 yielded a growth, thus emphasizingunreliability of clinical criteria to diagnose TBM. CSF biochemistry was found insignificant for thediagnosis of TBM (p=2.260). The CSF cytology, however, was found significant for diagnosing TBM(p=0.001).Conclusions: The study showed that BACTEC MGIT 960 can be effectively used as a rapiddiagnostic tool for the diagnosis of extra pulmonary tuberculosis.Keywords: Mycobacterium tuberculosis, Cerebrospinal fluid, BACTEC MGIT 960, Tuberculousmeningiti
Thilothammal N, Krishnamurthy PV, Banu K, Ratnum SR.
Tuberculous meningitis in children-clinical profile,
mortality,and morbidity of bacteriologically confirmed cases.
Indian Pediatr Jun 1995;32:641–7.
Ahmedinejad Z, Ziaee V, Aghsaeifar M, Reiskarami SR, The
prognostic factors of tuberculous meningitis. Int J Infect Dis
Gray JW. Childhood tuberculosis and its early diagnosis. Clin
Quan C, Lu CZ, Qiao J, Xiao BG, Li X. Comparative evaluation
of early diagnosis of tuberculous meningitis by different assays.
J Clin Microbiol 2006;44:3160–6.
Johansen IS, Lundgren B, Tabak F, Petrini B, Hosoglu S,
Saltoglu N, et al. Improved sensitivity of nucleic acid
amplification for rapid diagnosis of tuberculous meninigits. J
Clin Microbiol July 2004;42:3036–40.
Johansen IS. Rapid diagnosis of mycobacterial diseases and their
implication on clinical management. Dan Med Bull 2006;53:28–
Raviglione MC, O’Brien RJ. Tuberculosis. In: Kasper DL,
Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL,
(editors). Harrison’s Principles of Internal Medicine. Vol-1, 16th
ed. USA: McGraw-Hill; 2005.p. 953–66.
Nahid P, Pai M, Hopwell PC. Advances in the diagnosis and
treatment of tuberculosis. Proc Am Thorac Soc 2006;3:103–10.
Palomino JC. Nonconventional and new methods in the
diagnosis of tuberculosis: feasibility and applicability in the
field. Eur Respir J 2005;26:339–50.
New Technologies for Tuberculosis Control: A framework for
their adoption, introduction and implementation.
WHO/HTM/STB/2007.40. Available: from:
Lee JJ, Suo J, Lin CB, Wang JD, Lin TY, Tsai YC.
Comparative evaluation of the BACTEC MGIT 960 system
with solid medium for isolation of mycobacteria. Int J Tuberc
Lung Dis 2003;7:569–74.
Ardito F, Posteraro B, Sanguinetti M, Zanetti S, Fadda G.
Evaluation of BACTEC Mycobacteria Growth Indicator Tube
(MGIT 960) automated system for drug susceptibility testin`1g of
Mycobacterium tuberculosis. J Clin Microbiol 2001;39:4440–4.
Hillemann D, Richter E, and Gerdes SR. Use of the BACTEC
Mycobacteria Growth Indicator Tube 960 automated system for
recovery of mycobacteria from 9,558 extrapulmonary
J Ayub Med Coll Abbottabad 2010;22(4)
specimens, including urine samples. J Clin Microbiol
Cruciani M, Scarparo C, Malena M, Bosco O, Serpelloni G,
Mengoli C. Meta-analysis of BACTEC MGIT 960 and
BACTEC 460 TB, with or without solid media, for detection of
mycbacteria. J Clin Microbiol 2004;42:2321–25.
Pehme L, Hollo V, Rahu M, Altraja A. Tuberculosis during
fundamental societal changes in Estonia with special reference
to extrapulmonary manifestations. Chest 2005;127;1289–95.
Jagota P, Suryanarayana HV, Chadha VK. Childhood
tuberculosis today. Ind J Med 1997;8:121–4.
Gill GV, Krige LP, Pelly MD. Overdiagnosis of tuberculosis.
Case reports. S Afr J 1983;11:933–5.
Dippenaar J. Overdiagnosis of tuberculosis. A report of 3 cases.
S Afr Med J 1986;70:841–2.
Garrigo M, Aragon LM, Alcaide F, Borrel S, Cardenosa E,
Galan JJ, et al. Multicentre laboratory evaluation of MB/Bact
Mcobacterium detection system and the BACTEC MGIT 960 in
comparision with the BACTEC 460TB system susceptibility
testing of Mycobacterium tuberculosis. J Clin Microbiol
Lu DD, Heeren B, Dunne WM. Comparison of the automated
Mycobacteria Growth Indicator Tube System (BACTEC
/MGIT) with Löwenstein-Jensen medium for recovery of
Mycobacteria from clinical specimens Am J Clin Pathol
Pfyffer G, Welscher HM, Kissling P, Cieslak C, Casal MJ,
Gutierrez J, et al. Comparison of the Mycobacteria Growth
Indicator Tube (MGIT) with radiometric and solid culture for
recovery of Acid-Fast Bacilli. Clin J Microbiol 1997;3:364–8.