Clinical Profile, Yield of Cartridge-based Nucleic Acid Amplification Test (GeneXpert), and Outcome in Children with Tubercular Meningitis.
GeneXpert
Ommaya reservoir
hydrocephalus
tubercular meningitis
ventriculoperitoneal shunt
Journal
Journal of pediatric neurosciences
ISSN: 1817-1745
Titre abrégé: J Pediatr Neurosci
Pays: India
ID NLM: 101273794
Informations de publication
Date de publication:
Historique:
received:
11
07
2019
accepted:
18
11
2019
entrez:
3
2
2021
pubmed:
4
2
2021
medline:
4
2
2021
Statut:
ppublish
Résumé
GeneXpert MTB/RIF is a test for early, rapid diagnosis of tubercular meningitis (TBM). The aim of this article was to study the clinical profile, radiological features, yield of GeneXpert, neurosurgical interventions, and outcome of TBM in children. This was a retrospective and prospective observational study. Diagnosis was based on the uniform research definition criteria and was staged according to the British Medical Research Council. Mantoux test, analysis of cerebrospinal fluid (CSF), CSF GeneXpert, and radiological investigations were performed. Of 36 patients, 50% were aged 1-5 years. Fever (100%), headache (82%), altered sensorium (80%), and vomiting (66%) were common features. Twelve (33%) had contact with active case of tuberculosis; 32 received Bacille Calmette Guarin vaccination. Neurological features included severe deterioration in sensorium (Glasgow Coma Scale < 8) (38%), mild and moderate deficit in sensorium (31%), hemiparesis (41%), and involvement of sixth (25%) and seventh (22%) cranial nerves. Cerebral vision impairment (25%), papilledema (25%), and dystonia (22%) were other findings. CSF GeneXpert was positive in 37% (12/33) patients. Hydrocephalus and basal exudates (75%) were noted on neuro-imaging. Surgical intervention was performed in children with hydrocephalus (13/27). Omayya reservoir was placed in seven children, of which five needed conversion to ventriculoperitoneal (VP) shunt; direct VP shunt was carried out in six (6/13). Good outcome was noted in 78% at discharge. Stage III TBM ( GeneXpert has high diagnostic specificity, but negative results do not rule out TBM. CSF GeneXpert provided quick results. Placement of Ommaya reservoir in TBM stage II and III with hydrocephalus was not successful. Hydrocephalus was managed conservatively with success (53%).
Sections du résumé
BACKGROUND
BACKGROUND
GeneXpert MTB/RIF is a test for early, rapid diagnosis of tubercular meningitis (TBM).
AIM
OBJECTIVE
The aim of this article was to study the clinical profile, radiological features, yield of GeneXpert, neurosurgical interventions, and outcome of TBM in children.
SETTINGS AND DESIGN
METHODS
This was a retrospective and prospective observational study.
MATERIALS AND METHODS
METHODS
Diagnosis was based on the uniform research definition criteria and was staged according to the British Medical Research Council. Mantoux test, analysis of cerebrospinal fluid (CSF), CSF GeneXpert, and radiological investigations were performed.
RESULTS
RESULTS
Of 36 patients, 50% were aged 1-5 years. Fever (100%), headache (82%), altered sensorium (80%), and vomiting (66%) were common features. Twelve (33%) had contact with active case of tuberculosis; 32 received Bacille Calmette Guarin vaccination. Neurological features included severe deterioration in sensorium (Glasgow Coma Scale < 8) (38%), mild and moderate deficit in sensorium (31%), hemiparesis (41%), and involvement of sixth (25%) and seventh (22%) cranial nerves. Cerebral vision impairment (25%), papilledema (25%), and dystonia (22%) were other findings. CSF GeneXpert was positive in 37% (12/33) patients. Hydrocephalus and basal exudates (75%) were noted on neuro-imaging. Surgical intervention was performed in children with hydrocephalus (13/27). Omayya reservoir was placed in seven children, of which five needed conversion to ventriculoperitoneal (VP) shunt; direct VP shunt was carried out in six (6/13). Good outcome was noted in 78% at discharge. Stage III TBM (
CONCLUSION
CONCLUSIONS
GeneXpert has high diagnostic specificity, but negative results do not rule out TBM. CSF GeneXpert provided quick results. Placement of Ommaya reservoir in TBM stage II and III with hydrocephalus was not successful. Hydrocephalus was managed conservatively with success (53%).
Identifiants
pubmed: 33531936
doi: 10.4103/jpn.JPN_92_19
pii: JPN-15-224
pmc: PMC7847089
doi:
Types de publication
Journal Article
Langues
eng
Pagination
224-230Informations de copyright
Copyright: © 2020 Journal of Pediatric Neurosciences.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
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