[Rapid diagnosis of tuberculous meningitis by polymerase chain reaction. A case in an infant]
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1Clinique médicale infantile, hôpital Sud, CHRU, Rennes, France.
Abstract:
A fifteen-month-old child was admitted with a week history of isolated fever. On CSF (Cerebral Spinal Fluid) examination, hyperproteinorachy, hyperglycorachy and hypochlorurachy were found. The diagnosis of tuberculosis meningitis was suspected but usual tests were unable to find Mycobacterium tuberculosis in CSF, urine and sputum. Only the Polymerase Chain Reaction detected the Mycobacterium tuberculosis genome in the CSF. A specific treatment was started immediately. Apyrexia was obtained within 2 days; the outcome was favorable, without sequelae.
Insights
Early detection of tuberculosis meningitis in infants is crucial. Polymerase Chain Reaction (PCR) in cerebrospinal fluid (CSF) offers a rapid and accurate diagnosis when traditional methods fail, leading to favorable outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Neuroscience
- Microbiology
Background:
- Tuberculosis meningitis (TBM) is a severe form of extrapulmonary tuberculosis, particularly dangerous in infants.
- Diagnosis can be challenging due to non-specific symptoms and low bacterial loads in conventional tests.
- Cerebrospinal fluid (CSF) analysis is key, but Mycobacterium tuberculosis detection is often difficult.
Observation:
- A 15-month-old infant presented with isolated fever and abnormal CSF findings (elevated protein, glucose, and low chloride).
- Standard microbiological tests for Mycobacterium tuberculosis in CSF, urine, and sputum were negative.
- Polymerase Chain Reaction (PCR) on CSF uniquely identified the Mycobacterium tuberculosis genome.
Findings:
- PCR demonstrated high sensitivity in detecting Mycobacterium tuberculosis in CSF, enabling a definitive diagnosis.
- Prompt initiation of specific anti-tuberculosis treatment followed the PCR diagnosis.
- The child experienced rapid fever resolution within 2 days and recovered without neurological sequelae.
Implications:
- PCR testing for Mycobacterium tuberculosis in CSF should be considered in pediatric cases of suspected meningitis with inconclusive conventional results.
- Rapid molecular diagnostics like PCR can significantly improve TBM diagnosis and patient outcomes.
- Early and accurate diagnosis of TBM is critical for preventing long-term morbidity and mortality in young children.