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Indian Journal of Medical Microbiology, Vol. 24, No. 3, July-September, 2006, pp. 237 Correspondence Culture proven cases of tuberculous meningitis: A 5 year retrospective analysis from Vellore Jesudason MV, Gladstone P Department of Clinical Microbiology, Christian Medical College, Vellore - 632 004, Tamil Nadu Code Number: mb06071 Dear Editor, Tuberculous meningitis (TBM) is a common entity n children and also in adults with prediosposing factors such as AIDS, alcoholism, diabetes mellitus, malignancy and use of steroids. TBM often leads to considerable morbidity and mortality. We present here CSF culture positive cases of TBM reported between 2000 and 2004 from our institution. CSF specimens from patients suspected of TBM were processed for microscopy (stained by auramine O), culture [on Lowenstein Jensen (LJ) medium] and identification (by niacin test). A total of 2473 CSF specimens were received of which 96 (3.8%) grew M. tuberculosis . Fifteen (15.6%) of them were from patients with HIV and 15(15.6%) from children below 10 years of age. This is contrary to the belief that CSF culture positivity for SFB is very rare. A high degree of uncertainty prevails regarding TBM because of its diverse clinical features; therefore TBM is often missed or diagnosed late. Several immunological and molecular rapid tests have evolved over the year for an early diagnosis but most of them lack sensitivity and specificity.[1],[2] Moreover molecular tests are note feasible in small laboratories, where they still rely on smear alone and culture by conventional methods. One study from our department reported PCR results on CSF as 71% sensitive and 97% specific.[3] Many reports have shown that in countries with high TB prevalence, TBM is seen more in children below 5 years.[1] Paradoxically our study shows a higher prevalence in adults although India is known for high TB prevalence. It may be attributed to various TBM related predisposing factors. Regular reporting of the prevalence of TBM would pave the way for of tests for an "early diagnosis" and better management of this condition. References
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