Conventional PCR usage for the detection of Mycobacterium Tuberculosis complex in Cerebrospinal Fluid by MPB64-Target PCR

Tuberculous meningitis is a severe and potentially fatal form of Tuberculosis. Diagnosis of Tuberculous meningitis (TBM) is challenging. Thus rapid, accurate and confirmatory diagnosis is necessary to initiate required therapy. The diagnostic workup involves detection of acidfast bacilli (AFB) in the cerebrospinal fluid (CSF) by microscopy or culture, however, the difficulty in detecting the organism poses a challenge to diagnosis. The use of the polymerase chain reaction (PCR) in the diagnostic approach to Mycobacterium tuberculosis (MTB) meningitis has been reported as a fast and accurate method using in- house protocols and several commercial kits available. We analysed the performance of PCR for the diagnosis of MTB meningitis in 64 consecutive patients, using MTB culture as gold standard.We used PCR as a tool for detecting mycobacterial mpb64 gene in CSF samples from suspected TB patient. 64 clinical specimens were taken from the patients attending SMI Hospital, Dehradun. 45 were PCR positive, 32 were culture positive and 2 were Zn smear positive.The sensitivity of PCR, culture and microscopy for CSF samples was, thus, 70%, 50% and 3% respectively. Therefore, compared to the conventional culture assay, the PCR can be considered a more useful and advanced technique for the rapid and accurate diagnosis of TBM. Thus PCR is better tool for the diagnosis of Tuberculous meningitis combined with the other concerned tests.

Author(s): Sharma Narotam, Sharma Veena, Nautiyal Satish Chandra1, Singh Prem Raj, Rajeev S Kushwaha, Sailwal Shivani, Ghosh Shayan, Naushad Ahmer, Singh R.K

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