Mohanty Chinmayee, Mohanty Triyambakesh, Kar Sarita, Kumar Sujeet, Rout Sunil Swick, Bal Himadri Bhusan, Barik Subrat Kumar, Turuk Jyotirmayee, Das Dasarathi, Sundaray Sooman, Hota Prasanta Kumar, Pati Sanghamitra, Giri Sidhartha
ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, Odisha, India.
Government of Odisha, India.
Indian J Tuberc. 2025 Jan;72(1):46-50. doi: 10.1016/j.ijtb.2023.09.007. Epub 2023 Sep 16.
The burden of tuberculous meningitis varies substantially by location, and is influenced by the overall burden of tuberculosis in that geographical area, and the age structure of the population. Conventional methods for diagnosis of tuberculous meningitis include acid fast bacilli (AFB) smear and culture. AFB smear has low sensitivity and culture techniques are time consuming. During the last few years, rapid and sensitive molecular methods such as cartridge based nucleic acid amplification technique (CBNAAT) is being used for the diagnosis of tuberculous meningitis. In this study, we evaluated the burden of tuberculosis and rifampicin resistance in suspected cases of tuberculous meningitis in Bhubaneswar, Odisha, during February 2016 to December 2022 using CBNAAT.
Under the National Strategic Plan 2012-2017, CBNAAT machines were rolled out in 2016, of which 1 was installed in the National Reference Laboratory (NRL) for Tuberculosis in Bhubaneswar. For this study, retrospective data on CBNAAT testing of cerebrospinal fluid (CSF) samples at the NRL was collected and analyzed from February 2016 to December 2022. All the demographic and laboratory data were entered in Excel 2010 (Microsoft office, USA) for data analysis. The age and sex distribution of the presumptive TB patients, proportion of samples referred from public and private health care facilities, proportion of M. tuberculosis positive CSF samples along with sensitivity to rifampicin was evaluated. The study was approved by the Institutional Human Ethics Committee.
During February 2016 to December 2022, a total of 1627 CSF samples from presumptive TB meningitis patients were received in the NRL for CBNAAT testing. 60.7% (988/1627) of the presumptive TB patients were males. Of the 1627 patients, 3.1% (50/1627) were positive for M. Tuberculosis by CBNAAT. 56% (28/50) of the patients positive for tuberculous meningitis were males. The positivity for M. tuberculosis varied from 2.1% in 2017 to 5.1% in 2021. The CSF positivity for M. tuberculosis ranged from 0.7% in patients aged >60 years to 6.1% in 15-30 years age group. Of the 50 M. tuberculosis positive samples, 6% (3/50) were resistant for rifampicin.
Our study which included more than 1600 samples over a period of approximately 7 years found a 3.1% positivity for M. tuberculosis in CSF samples using CBNAAT. 6% of the M. tuberculosis positive samples were resistant to rifampicin. Future studies involving data from other districts of Odisha will help provide a more accurate information on the prevalence of tuberculous meningitis in Odisha state.
结核性脑膜炎的负担因地区而异，受该地理区域结核病的总体负担以及人口年龄结构的影响。结核性脑膜炎的传统诊断方法包括抗酸杆菌（AFB）涂片和培养。AFB涂片敏感性低，培养技术耗时。在过去几年中，基于 cartridge 的核酸扩增技术（CBNAAT）等快速灵敏的分子方法被用于结核性脑膜炎的诊断。在本研究中，我们使用CBNAAT评估了2016年2月至2022年12月期间奥里萨邦布巴内斯瓦尔疑似结核性脑膜炎病例中的结核病负担和利福平耐药情况。
根据《2012 - 2017年国家战略计划》，CBNAAT机器于2016年推出，其中1台安装在布巴内斯瓦尔的国家结核病参考实验室（NRL）。对于本研究，收集并分析了2016年2月至2022年12月期间NRL对脑脊液（CSF）样本进行CBNAAT检测的回顾性数据。所有人口统计学和实验室数据都录入Excel 2010（美国微软办公软件）进行数据分析。评估了疑似结核病患者的年龄和性别分布、来自公共和私立医疗机构的样本比例、结核分枝杆菌阳性CSF样本的比例以及对利福平的敏感性。该研究获得了机构人类伦理委员会的批准。
2016年2月至2022年12月期间，NRL共接收了1627份疑似结核性脑膜炎患者的CSF样本进行CBNAAT检测。60.7%（988/1627）的疑似结核病患者为男性。在这1627名患者中，CBNAAT检测显示3.1%（50/1627）的患者结核分枝杆菌呈阳性。结核性脑膜炎呈阳性的患者中56%（28/50）为男性。结核分枝杆菌的阳性率从2017年的2.1%到2021年的5.1%不等。结核分枝杆菌的CSF阳性率在年龄>60岁的患者中为0.7%，在15 - 30岁年龄组中为6.1%。在50份结核分枝杆菌阳性样本中，6%（3/50）对利福平耐药。
我们的研究在大约7年的时间里纳入了1600多个样本，发现使用CBNAAT检测CSF样本时结核分枝杆菌的阳性率为3.1%。6%的结核分枝杆菌阳性样本对利福平耐药。未来涉及奥里萨邦其他地区数据的研究将有助于更准确地了解奥里萨邦结核性脑膜炎的患病率。
