Tubercular Meningitis: The chronic disease with its emergent foot!

Abstract

Context: Tubercular meningitis; the most feared complication of tuberculosis poses significant diagnostic challenges and has a high morbidity and mortality.

Aims: To evaluate clinical, laboratory and radiological parameters in patients with suspected tubercular meningitis.

Settings and Design: This was a cross sectional observational study conducted in a tertiary care health centre in New Delhi, India from 2012-2015.

Material and Methods: Patients ? 18 years of age, with a diagnosis of tubercular meningitis according to Marais’ case definition criteria underwent detailed history, clinical examination, CSF analysis, culture, Real time polymerase chain reaction, Amplified Mycobacterium tuberculosis Direct Testing and appropriate radiological studies.

Statistical analysis: The correlation between quantitative variables was carried out by Pearson’s correlation coefficient (r) / non-parametric Spearmen’ rank correlation (?) with its statistical significance determined by t test. The qualitative variables were analysed by Student’s t-test/ non-parametric Man Whitney’s test and the association assessed by chi- square test / Fischer exact test.

Results: Out of 50 patients in this study definite diagnosis of TBM could be made in 74% patients. The sensitivities of ZN staining, culture, AMTDT and RT- PCR in CSF were 15.8%, 31.6%, 53.9%, and 73.7% for diagnosing definite TBM with respect to BacT/Alert as the gold standard while the sensitivities were 8.1%, 19%, 89.2%, 62.7% respectively using Marais’ case definition as the gold standard.

Conclusions: This study emphasizes that no single test can definitively rule out TBM. Thus, any suspected patient of TBM should undergo multiple tests to establish an early diagnosis.

Key-words:-Tubercular meningitis, Marais’ criteria, Medical Research Council.