Evaluation of gene-xpert in paediatric tuberculous meningitis cases: A hospital-based study

Abstract

Introduction: Tuberculous meningitis (TBM) is the infection of Mycobacterium tuberculosis (MTB) among extra-pulmonary organs. The diagnosis of TBM can be considered a double sword in low-resource settings. On one side, there is poor access to health-care services, limited diagnostic capacity, and poor affordability. These factors hamper early treatment initiation while in high-resource settings, clinical suspicion towards TBM is considered minimal, and this lack of recognition many times leads to treatment delay. Xpert MTB/RIF test has come up as the diagnostic rescue with overall sensitivities exceeding 80% and specificity up to 100%. Materials and Methods: An observational study was done on 368 children up to 14 years of either gender with suspected TBM in 18 months. This whole duration was consumed in the planning of the study, obtaining ethical clearance, data collection, data analysis and report writing. Cerebrospinal fluid was collected by lumbar puncture. Samples from all patients underwent testing based on GeneXpert, Ziehl–Neelsen (ZN) stain and mycobacteria growth indicator tube (MGIT) culture. IBM Statistical Package for the Social Sciences (SPSS version 22) was used for data analysis. Results: A total of 321 patients were included in the analysis. The male-to-female ratio was 1.55, thus showing a male preponderance. The majority belonged to Hinduism. The median age was 7.5 years. Based on clinical assessment and radiology, 48 patients were diagnosed with confirmed and probable TBM. Overall, the sensitivity of Gene Xpert, ZN smear and MGIT was 68.75%, 4.2% and 75.0%, respectively. Rifampicin sensitivity of the isolated organism was reported, and it was found that 18 out of 33 patients, implying 54.5% of patients were resistant to rifampicin. Conclusion: Till today, TBM poses a life-threatening situation despite advances made in the diagnosis have been achieved. In this context, Gene Xpert represents a step forward.