RAPID CONFIRMATION OF TUBERCULOUS MENINGITIS IN CHILDREN BY LIQUID CULTURE MEDIA
Abstract
Background: 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, TuberculousmeningitiReferences
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