An Observational, Cross-sectional Study on Epidemiology and Clinical Spectrum of Tuberculous Meningitis in a Tertiary Care Hospital in Eastern India and Role of CSF CBNAAT for Rapid Diagnosis

Abstract

Background: Tubercular meningitis (TBM) accounts for 70 to 80 percent of all neurological tuberculosis and is a major health issue in a country like India. But we don’t have adequate amount of data regarding the epidemiology and clinical pattern of TBM. In this study we aimed at exploring the epidemiological, clinical picture of TBM and compared different diagnostic modalities for early detection. Methods and Materials: 50 patients with history and clinical features compatible with tuberculous meningitis were assessed through a detailed history and clinical examination followed by CSF study and an MRI of the brain. Results: CSF study showed lymphocytic pleocytosis (92% cases) along with raised mean CSF protein 182.2±80.2 mg/dl (Mean ± SD) and reduced mean sugar 35.8 ±12.3mg/dl. CSF for AFB had least sensitivity (4%) but highest specificity (100%). CBNAAT showed both acceptable sensitivity (77%) and specificity (96%). CSF ADA had high sensitivity (85%)but low specificity (18%). Age >40 years, Altered consciousness, GCS<10, TBM stage 3, CSF glucose ≤30mg/dl& Presence of hydrocephalus were significantly associated with mortality from TBM (p-value<0.05). Conclusion: CSF CBNAAT having acceptable sensitivity and specificity for diagnosis of TBM and can be used for early diagnosis as an alternative to CSF culture due to its rapidity and other bio-medical advantages. Factors associated with adverse outcome can be used in future as components of risk prediction models.