Positivity of Cerebrospinal Fluid Genexpert MTB PCR Among Suspected Tuberculous Meningitis Patients

Abstract

Background: Tuberculous (TB) meningitis is the most severe form of tuberculosis and therefore, a rapid and accurate diagnostic test would greatly benefit timely and adequate  management of patients. Genexpert MTB PCR for diagnosis of TB meningitis may be more  sensitive, possibly due to the use of Genexpert MTB PCR, DNA extraction methods. The  objective of our study to explore positivity of Cerebrospinal Fluid (CSF) Genexpert MTB PCR  among suspected TB meningitis patients

Materials and methods: It was a cross-sectional descriptive study carried out in Department of Medicine, Chittagong Medical college Hospital. Twenty five patients patients presented with clinically suspected tubercular meningitis were included in this study. After complete physical  examination a sample of CSF was collected by lumbar puncture and sent for biochemical, microbiological, hematological analysis and Genexpert MTB PCR. Data were analyzed by SPSS-23.

Results: Among 25 patients 6(24%) were at age group <20 years, 11(44%) were at 20 –40 years, 6(24%) were at age group 40-60 years and 2(8%) were at age group >60 years. Regarding gender distribution male was 12(48%) and female was 13(52%). Male to female  ratio was 0.92: 1. Occupation of the study patients revealed service holder was 3(12%) farmer was 3(12%) businessman was 1(4%) housewife was 11(44%) student was 6(24%) and others was 1(4%). Regarding socioeconomic status of the study patients lower class was 7(28%) lower middle class was 13(52%) and upper middle class was 5(20%). one had DM and 2(8%) had hypertension. Analysis of clinical features revealed fever was present in 21(84%) cases, headache was present in 17(68%) cases and vomiting was present in 10(40%) cases. Regarding examination findings focal neurological deficit was present in 9(36%), neck stiffness was present in 14(56%), decrease level of consciousness was present in 14(56%) and cranial nerve  palsy was present in 5(20%) cases. In CSF study 7(28%) case had clear CSF and 18(72%) turbid CSF, <10/cmm cells was found in 5(20%) cases, 10-500/cmm cell found in 14(56%) cases and >500 /cmm cells was found in 6(26%) cases, 4(16%) cases had <50%  lymphocyte  count and 21(84%) had >50% lymphocyte in CSF. One patient  had <45mg/dl  CSF protein, 10(40%) patients had 45-100mg/dl and  14(56%) had >100mg/dl  protein in CSF, 20(80%) patients had CSF glucose <40mg/dl,11(44%) case had ADA 5-10 u/l  and 14(56%) had ADA >10u/l, all cases were found CSF AFB negative but 8(32%) patients had CSF gene expert positivity. Patients those have high CSF protein and traditional CSF AFB  negative, had high gene expert positivity.

Conclusion: Modern test Genexpert can be successfully used in the diagnosis of tubercular meningitis in our context

JCMCTA 2026 ; 37 (1) : 108-114