Abstract
Background: Tubercular meningitis (TBM) remains a major complication in children with a considerable mortality and morbidity. Inconsistent and variable clinical features coupled with lack of rapid, sensitive and specific tests poses a diagnostic challenge to the clinical acumen. This study was carried out to diagnose TBM by a combination of direct microscopy by Ziehl-Neelsen (ZN) staining, culture by conventional Lowenstein Jensen (LJ) media and Bactec MGIT 960 system in clinically suspected cases TBM and compare the utility of these diagnostic modalities in the diagnosis of paediatric TBM. Methods: A total of 50 cerebrospinal fluid (CSF) samples from suspected cases of TBM in children aged 0-12 years of age were processed for direct acid fast bacilli (AFB) smear examination, and culture on LJ media and automated Bactec MGIT 960 system. Results: The study comprised of 32 male and 18 female patients in the age group of 0-12 years with a male to female ratio of 1.77: 1. 1 (2%) out of 50 samples was positive for AFB by ZN staining. Overall culture was positive in 15 cases (30%). Culture by LJ media was positive in 4 (8%) of the cases while culture by Bactec MGIT 960 system was positive in 14 cases (28%). The mean time of detection of Mycobacterium tuberculosis in LJ media and MGIT were 13.2 days and 32.4 days, respectively. Conclusion: Automated Bactec MGIT 960 system increases the sensitivity of diagnosing TBM in comparison to conventional microscopy and culture and reduces the mean time to diagnosis.
Highlights
Tuberculosis (TB) in the paediatric age group continues to be a global health problem especially so in countries with high burden of TB
Bacilli (AFB) microscopy and conventional Lowenstein Jensen (LJ) culture is quite low in cerebrospinal fluid (CSF) which contains a small number of organisms. [2,4] The nucleic acid assays are limited by their high costs and can serve only as adjuncts and not substitutes per se of conventional tests.[5]
Culture by LJ media was positive in 4 of the cases and all the cases belonged to Mycobacterium tuberculosis species without any presence of non-tuberculous mycobacteria
Summary
Tuberculosis (TB) in the paediatric age group continues to be a global health problem especially so in countries with high burden of TB. In the face of such limitations, the need of the hour is for less complicated and more accurate diagnostic tests Liquid culture media such as that used in the Mycobacterial Growth Indicator Tube (MGIT) (Becton Dickinson) system have been introduced over the years and been extensively evaluated.[7] The BACTEC MGIT 960 system was developed as a non-radiometric, fully automated, continuous monitoring system to serve as an alternative to the radiometric BACTEC 460 for growth and detection of www.ssjournals.com. This study was carried out to diagnose TBM by a combination of direct microscopy by ZiehlNeelsen (ZN) staining, culture by conventional Lowenstein Jensen (LJ) media and Bactec MGIT 960 system in clinically suspected cases TBM and compare the utility of these diagnostic modalities in the diagnosis of paediatric TBM. Methods: A total of 50 cerebrospinal fluid (CSF) samples from suspected cases of TBM in children aged 0-12 years of age were processed for direct acid fast bacilli (AFB) smear examination, and culture on LJ media and automated Bactec MGIT 960 system.
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