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Cited by 8Infectious Diseases and TuberculosisTuberculosis Research and EpidemiologyBacterial Identification and Susceptibility Testing

Diagnostic performance of real time PCR for the detection of Mycobacterium tuberculosis in cerebrospinal fluid samples

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Krishnakumariamma, Krishnapriya, Ellappan, Kalaiarasan, Muthuraj, Muthaiah, Tamilarasu, Kadhiravan, Kumar, Saka Vinod, Joseph, Noyal Mariya·2023·Indian Journal of Medical Microbiology
DOI 10.1016/j.ijmmb.2022.12.012
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Abstract

PURPOSE: We aimed this study to standardize real time - polymerase chain reaction (RT-PCR) for the detection of Mycobacterium tuberculosis (Mtb) in cerebrospinal fluid (CSF) samples and compare its diagnostic performance with GeneXpert (Xpert), Mycobacteria Growth Indicator Tube (MGIT) and Multiplex PCR (MPCR) for tuberculous meningitis (TBM). METHODOLOGY: A total of 217 CSF samples were obtained from patients with suspected TBM during the study period between January 2019 and December 2021. The optimal cycle threshold (CT) of RT-PCR was determined by comparing different gene targets of Mtb (IS6110, 16SrRNA, HSP65 and Ag85B). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was determined for RT-PCR, Xpert, MGIT960 and MPCR. Diagnostic accuracy of these assays was compared by using clinical diagnosis as reference standard. RESULTS: IS6110RT-PCR was found to be highly sensitive as compared to other gene targets. Sensitivities of IS6110RT-PCR, MPCR, Xpert and MGIT against a reference standard of definite, probable and possible TBM were 36.7%, 21.1%, 16.7% and 6.7%, respectively; specificities were 97.6%, 100%, 100% and 100%, respectively. Xpert, RT-PCR, MPCR and MGIT960 detected 6.91% (n = 15), 5.99% (n = 13), 5.99% (n = 13) and 2.76% (n = 6) of definite TBM, respectively. RT-PCR detected 6.45% (n = 14) and 2.76% (n = 6) of possible TBM and probable TBM, respectively and MPCR detected 1.38% (n = 3) of possible and probable TBM each. CONCLUSION: IS6110RT-PCR is highly sensitive for primary screening of suspected TB cases, which may help clinicians to start appropriate patient's treatment with clinical suspicion of TBM.

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  • Studies of IS6110 PCR for tuberculous meningitis reported sensitivity between 72% and 100% (median 91%) and specificity between 82% and 100% (median 99%).

    “Several studies, with sample sizes ranging from 13 to 102 definite tuberculous meningitis patients and 17 to 127 controls, studied the performance of IS6110 PCR and reported a sensitivity between 72% and 100% (median 91%) with a specificity between 82% and 100% (median 99%) (73–78).”

    From Molecular diagnostics in cerebrospinal fluid for the diagnosis of central nervous system infections (2024) · cites this paper as [75]

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Authors
Krishnakumariamma, K., Ellappan, K., Muthuraj, M., Tamilarasu, K., Kumar, S. V., & Joseph, N. M.
Affiliations
Jawaharlal Institute of Post Graduate Medical Education and Research (IN)
Corresponding author
Joseph, Noyal Mariya
ORCID
Venue
Indian Journal of Medical Microbiology
Publisher
Elsevier BV
Published
2023-03
Volume
42
Pages
7-11
ISSN
0255-0857 (ISSN-L)
DOI
10.1016/j.ijmmb.2022.12.012
OpenAlex
W4317486125
Cited by
8
References
25
Citations by year
2026: 2 · 2025: 3 · 2024: 2 · 2023: 1
FWCI
2.15
Type
journal article
Language
en
Open access
Licence
Locations
  • Indian Journal of Medical Microbiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
Jawaharlal Institute Of Postgraduate Medical Education and Research
Topics
  • Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
  • Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
Keywords
Mycobacterium tuberculosis, tuberculous meningitis, cerebrospinal fluid, real-time PCR, IS6110, diagnostic accuracy, GeneXpert, multiplex PCR, tuberculosis screening
MeSH terms
Cerebrospinal Fluid, Humans, Mycobacterium tuberculosis, Predictive Value of Tests, Sensitivity and Specificity, Tuberculosis, Meningeal, Real-Time Polymerase Chain Reaction

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