A clinical study of tubercular meningitis with special emphasis on CSF PCR as a diagnostic tool
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 4, Pages 3840-3847
AbstractThe detection of mycobacterium tuberculosis (M.TB)DNA in the cerebrospinal fluid(CSF) through the use of various molecular methods, particularly polymerase chain reaction (PCR)assay, has emerged as a promising new method for the diagnosis of CNS tuberculosis because of its rapidity, sensitivity, and specificity.
Aims: To study the clinical profile & the role of CSF PCR as an early diagnostic tool in TB meningitis.
Materials and Methods: After clinical evaluation and preliminary tests, patients are separated into two groups, Tubercular meningitis & Non-tubercular meningitis. A technique, polymerase chain reaction (PCR) is used to create enough copies of a particular area of DNA to be tested on CSF.
Results: In the study, 30 individuals had tuberculous meningitis, 13 had pyogenic meningitis, 26 had viral meningitis and 1 had fungal meningitis. TB meningitis patients ranged in age from 18 to 75, with a mean age of 41.8. Mantoux test findings were positive in 86.7% of TBM, 38.5% of pyogenic, and 42.3% of viral meningitis patients. 6.7% of TBM patients had HIV, 7.7% of viral meningitis patients did, but none of pyogenic meningitis patients did. Every patient with TBM, 92.3% with pyogenic, and 53.8% with viral meningitis had elevated CSF Protein. TBM trumps viral and pyogenic. In the TBM group, 83.3% of patients had high ADA levels, 3.8% had viral meningitis, and all pyogenic meningitis patients had normal ADA levels. Gold standard CSF TB PCR and clinical diagnosis, with Sensitivity and specificity of CSF TB PCR are 56.67% and 100%. The sensitivity and specificity of ADA are 83.3 and 97.5%.
Conclusion: PCR alone should not be used as a rationale for starting or stopping the therapy because false negative findings on PCR are sometimes reported. In order to assist clinicians in selecting the best course of treatment, whenever practical, it should be supported by clinical, radiographic, cytological, and other microbiological results (smear microscopy and culturing by traditional and automated technologies).
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