Open AccessPerformance of newer and conventional diagnostic methods in detection of drug sensitive and resistant tuberculous meningitis
Author(s) -
Sangamithra Neelakantan,
Amita Jain,
Pooja Singh,
Shantanu Prakash,
Pratibha Dixit,
Rajkumar Kalyan,
Ravindra Kumar Garg,
Rashmi Kumar,
Mastan Singh
Publication year - 2014
Publication title -
asian pacific journal of tropical disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.208
H-Index - 33
ISSN - 2222-1808
DOI - 10.1016/s2222-1808(14)60698-8
Subject(s) - ethambutol , rifampicin , isoniazid , streptomycin , medicine , tuberculous meningitis , drug resistance , mycobacterium tuberculosis , genexpert mtb/rif , tuberculosis , drug , microbiology and biotechnology , antibiotics , virology , biology , pathology , pharmacology
Objective: To compare the performance of traditional and newer diagnostic methods for\uddiagnosis of tuberculous meningitis (TBM) along with detection of drug resistant TBM.\udMethods: Single cerebrospinal fluids sample from 281 suspected TBM patients was processed\udduring August 2011 to July 2012 for acid fast bacilli (AFB) examination by Ziehl-Neelsen and\udauramine staining methods, AFB culture on Lowenstein-Jensen culture media, by microscope\udobservation of drug susceptibility testing assay, and nucleic acid amplification tests by inhouse conventional PCR and in-house real time PCR targeting IS6110 insertion sequence. All the\udisolates were subjected to drug susceptibility testing for isoniazid, rifampicin, ethambutol and\udstreptomycin by 1% proportion method.\udResults: The percentage positivity by AFB smear examination and culture on Lowenstein-Jensen\udmedia was 21% (59/281), 11.4% (32/281) respectively. The detection rate by conventional PCR was\ud33.1% (93/281). The real time PCR showed positivity rate of 44.8% (126/281). The extra detection\udby real time PCR was 11.7%. Only one isolate was multiple drug resistant and 22 (68.8%) were\udpan-susceptible. Remaining eight isolates showed either mono/poly drug resistant to first line\udantitubercular drugs.\udConclusions: Real time PCR is a more sensitive and rapid method if it is appropriately adopted\udin clinical practice for diagnosis of TBM. Prevalence of multiple drug resistance Mycobacterium\udtuberculosis causing TBM is low