Utility of polymerase chain reaction technique in the diagnosis of tubercular meningitis in Indian children

Abstract

Despite tremendous advancement, tuberculosis remains a major global health problem due to multidrug resistance and HIV infection. In children's, tubercular meningitis (TBM) is the main presentation than that of pulmonary as after disease neurological problems, are more serious. Timely and accurate diagnosis is important for correct treatment and better outcome. The conventional methods (microscopy and culture) are reported either to give false results or fail to respond at early stage. The molecular biology techniques have offered a ray of hope over it. Methods: In the present study, 30 suspected cases of TBM along with 15 controls representing other forms of meningitis and of pediatric age group were diagnosed using PCR and conventional methods. Results: Only two samples showed positivity by microscopy and six samples showed positivity by culture. On the other hand by PCR, a significantly higher number (17, including microscopy and culture positive) were positive for the presence of TBM. All the control samples were negative by both the methods. Conclusions: PCR was able to detect additional 11 cases reportedly negative by culture and microscopy. It shows that a big quantum left undiagnosed and hence untreated. These results suggest that PCR definitely have an advantage over conventional methods especially in case of TBM where non-treatment due to poor diagnosis may lead to high morbidity and mortality. More emphasis needs to be given to the adoption of such rapid diagnostic methods in case of infections where the start of treatment may affect the infection outcome.