title: Role of the BACTEC radiometric method in the evaluation of patients with clinically probable tuberculous meningitis.
abstract: BACKGROUND
  Confirmation of tuberculous meningitis (TBM) and initiation of treatment are often delayed due to limitations in isolating Mycobacterium tuberculosis from cerebrospinal fluid (CSF).
  
  
  OBJECTIVE
  To evaluate the role of the BACTEC radiometric method in a clinical setting for the early diagnosis of TBM.
  
  
  METHODS
  Patients meeting criteria for clinically probable TBM over a 3 year period were included. Clinical features, results of CSF investigations (protein, glucose, cell count, Ziehl-Neelsen staining, culture in Löwenstein-Jensen (LJ) medium and BACTEC) and brain CT imaging were reviewed. Drug sensitivity was tested using BACTEC. Patients were started on standard treatment and functional outcome, and response at discharge and follow-up were assessed. Patients were divided according to whether or not M. tuberculosis was isolated by BACTEC and the clinical, radiological, and laboratory features compared.
  
  
  RESULTS
  Sixty patients were evaluated. The mean age was 30 years +/- 11.7 years. Headache and fever were the most common symptoms and the mean duration was 26 days. CT findings were hydrocephalus (n=21), basal exudates (n=16), and tuberculoma (n=14). In 40 patients, M. tuberculosis was isolated by BACTEC and average 15 days was required for detection, whereas it was 30 days in LJ medium. Results of drug-sensitivity testing (n=32) were obtained average 7 days after isolation. Patients from whom M. tuberculosis had been isolated by BACTEC more often had tuberculomas in CT imaging (P=0.018).
  
  
  CONCLUSIONS
  Use of the BACTEC method allows early confirmation in patients with clinically probable TBM. It can guide clinicians in the rational use of anti-tuberculosis treatment by confirming diagnosis and identifying drug- sensitivity.
authors.affiliation: Departments of Neurology, Biostatistics and Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, India. abhishek.m.srivastava@relianceada.com
authors.forename: Jalesh N
authors.initials: JN
authors.lastname: Panicker
authors.forename: D
authors.initials: D
authors.lastname: Nagaraja
authors.forename: D K
authors.initials: DK
authors.lastname: Subbakrishna
authors.forename: M M
authors.initials: MM
authors.lastname: Venkataswamy
authors.forename: A
authors.initials: A
authors.lastname: Chandramuki
references.citation: Pathol Res Pract. 2009;205(12):815-22
references.pmid: 19608350
references.citation: JAMA. 1979 Jan 19;241(3):264-8
references.pmid: 102806
references.citation: Tuber Lung Dis. 1994 Apr;75(2):149-52
references.pmid: 8032049
references.citation: J Clin Microbiol. 2004 Jan;42(1):378-9
references.pmid: 14715783
references.citation: Int J Tuberc Lung Dis. 2003 Aug;7(8):787-96
references.pmid: 12921156
references.citation: Med Clin North Am. 1985 Mar;69(2):315-31
references.pmid: 3990437
references.citation: Int J Tuberc Lung Dis. 2005 Dec;9(12):1391-7
references.pmid: 16466063
references.citation: Tuber Lung Dis. 1995 Oct;76(5):381-6
references.pmid: 7495997
references.citation: J Clin Microbiol. 2000 Jun;38(6):2395-7
references.pmid: 10835013
references.citation: Indian J Med Microbiol. 2007 Jul;25(3):236-40
references.pmid: 17901641