The Utility of CSF Xpert MTB/RIF in Diagnosis of Tubercular Meningitis in Children

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Jyothy A1, Vinod H Ratageri2, Shivanand Illalu1

  • 1Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubli, Karnataka, 580021, India.

Indian Journal of Pediatrics
|July 31, 2019
PubMed

Insights

The Xpert MTB/RIF test on cerebrospinal fluid (CSF) shows 100% specificity for diagnosing tuberculous meningitis (TBM) in children. This rapid molecular test is superior to traditional smear tests for acid-fast bacilli (AFB).

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Microbiology

Background:

  • Tuberculous meningitis (TBM) is a severe form of tuberculosis affecting children, often with challenging diagnosis.
  • Early and accurate diagnosis is crucial for effective treatment and improved outcomes in pediatric TBM.
  • Conventional diagnostic methods, such as acid-fast bacilli (AFB) smear microscopy, have limitations in sensitivity.

Purpose of the Study:

  • To evaluate the diagnostic utility of the Xpert MTB/RIF assay (GeneXpert) for tuberculous meningitis in children.
  • To compare the performance of CSF Xpert MTB/RIF with traditional diagnostic methods.

Main Methods:

  • A prospective observational study was conducted on 28 children clinically suspected of TBM.
  • Cerebrospinal fluid (CSF) samples were analyzed using the CSF Xpert MTB/RIF assay.
  • Statistical analysis was performed to determine sensitivity, specificity, and associations with clinical and laboratory findings.

Main Results:

  • The CSF Xpert MTB/RIF assay detected TBM in 6 out of 28 children (21.4%).
  • The test demonstrated a sensitivity of 46.15% and a specificity of 100% for TBM diagnosis.
  • Significant associations were found between positive CSF Xpert MTB/RIF results and Mantoux test, CSF lymphocyte predominance, elevated CSF protein, and CT scan findings like hydrocephalus.

Conclusions:

  • The Xpert MTB/RIF assay is a valuable tool for diagnosing tuberculous meningitis in children.
  • CSF Xpert MTB/RIF offers superior performance compared to AFB smear microscopy for TBM diagnosis.
Abstract

Keywords:
CSFChildrenClinical scoreTBMXpert MTB/RIF

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