INTRODUCTION

Tuberculous meningitis (TBM) in children is difficult to diagnose / confirm as the yield of CSF culture is low and is delayed for weeks. India is estimated to have 20% of all multi-drug resistant (MDR) TB worldwide. This tertiary hospital-based study was carried out to ascertain the usefulness of CSF culture in suspected TBM and look for drug resistance.

METHODS

Pediatric TBM patients admitted to the hospital were identified from the hospital’s medical records and Microbiology Department records. Chart reviews helped to classify patients into probable, possible and not TBM based on recent TBM consensus criteria (1). The BACTEC MGIT 960 system was used for culture. Drug sensitivity testing (DST) was done if requested by the referring clinician.

RESULTS

CSF from 48 patients were sent for TB culture over 3 years. 32 were classified probable, 9 as possible and 7 as not TBM. 20/ 41 (49%) suspected TBM patients had positive cultures – 16/32 (50%) probable cases and 4/9 (44%) possible cases.

DSTs were performed in 15/20 positive CSF cultures. In 7/15 (47%) the TB bacilli were sensitive while in 8 (53%) they were resistant: MDR in 7 and extensively drug resistant (XDR)in 1. Only 1/5 drug-naïve newly diagnosed TBM was MDR vis-à-vis 7/10 of those already on treatment.

CONCLUSION

Positive cultures are seen in half of childhood TBM patients in line with other Indian reports (2).  More than half were MDR/XDR probably due to a referral bias. Expectedly drug-naïve cases were more likely to be drug sensitive.