Wakode Priyanka, Siddaiah Nagarathna, Manjunath Netravathi, Bahubali Veena Kumari Haradara
Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
J Neurosci Rural Pract. 2022 Feb 18;13(2):204-210. doi: 10.1055/s-0041-1742138. eCollection 2022 Apr.
Tuberculous meningitis (TBM) is a highly lethal form of central nervous system tuberculosis (CNS TB) that causes high mortality and morbidity in children and adults. Nonspecific clinical presentation and fewer TB bacilli challenge clinicians resulting in delays in diagnosis and treatment. This study aimed to evaluate the utility of GeneXpert alone and in combination with culture using 1 mL of cerebrospinal fluid (CSF) in a volume constraint situation. A total of 125 clinically confirmed TBM and 110 non-TBM cases, comprised of both infectious and noninfectious diseases. were included in the study. Patient details including clinical signs and symptoms, CSF, and imaging data were collected from the case records. CSF samples were obtained from all the patients and were tested by the mycobacterial culture method and GeneXpert test. The performance of both the tests was statistically calculated and reported in the form of sensitivity and specificity. Out of 125 TBM cases, 40 were detected positive by culture and 26 by GeneXpert. All 110 non-TBM cases were identified negative by both methods. The sensitivity and specificity of GeneXpert in comparison with culture were 27 and 100%, respectively. The culture was found to be more sensitive (32%) than GeneXpert. But the assay was able to detect a considerable number of clinically confirmed culture-negative TBM cases. GeneXpert is a rapid test and including this as an adjunctive test along with the culture in routine clinical practice can improve the diagnosis of TBM in volume constraint scenario.
结核性脑膜炎（TBM）是中枢神经系统结核病（CNS TB）的一种高致死形式，在儿童和成人中会导致高死亡率和高发病率。非特异性临床表现以及结核杆菌数量较少给临床医生带来了挑战，导致诊断和治疗延迟。 本研究旨在评估在样本量受限的情况下，单独使用GeneXpert以及将其与使用1毫升脑脊液（CSF）进行的培养相结合的效用。 该研究共纳入了125例临床确诊的TBM病例和110例非TBM病例，后者包括感染性和非感染性疾病。从病例记录中收集了包括临床体征和症状、脑脊液以及影像学数据在内的患者详细信息。从所有患者中获取脑脊液样本，并通过分枝杆菌培养法和GeneXpert检测进行检测。对两种检测方法的性能进行了统计学计算，并以敏感度和特异度的形式报告。 在125例TBM病例中，40例培养检测呈阳性，26例GeneXpert检测呈阳性。所有110例非TBM病例两种方法检测均为阴性。与培养相比，GeneXpert的敏感度和特异度分别为27%和100%。发现培养比GeneXpert更敏感（32%）。但该检测方法能够检测出相当数量的临床确诊的培养阴性TBM病例。 GeneXpert是一种快速检测方法，在常规临床实践中将其作为培养的辅助检测方法可以在样本量受限的情况下改善TBM的诊断。
