Nelly Amalia Risan
Indonesian Paediatric Association
Department of Child Health
Infections of the central nervous system (CNS) are devastating medical emergencies that can lead to death or severe neurologic sequelae if not diagnosed and treated early.
Problems exist in the diagnosis of patients with bacterial meningitis, because clinical findings do not always accurately identifypatients with meningitis, and cerebrospinal fluid (CSF)analysis is not always diagnostic. Inresource-poor countries and poor laboratory diagnostics, establishmentof the diagnosis of bacterial meningitis can be even moredifficult.Conventional methods used in clinical microbiology laboratories include direct microscopic examination, cultures, antigen and antibody detection assays have several limitations. To overcome the limitations, molecular methods, such asPCR-based molecular methods detect deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) specific to infectious organisms as a means of diagnosis. Such tests have dramatically impacted both the diagnosis and management of infectious diseases. This is particularly true for CNS infections where rapid, accurate identification of a pathogen and prompt initiation of antimicrobial therapy are potentially lifesaving.
The diagnosis of TBM remains a challenge because of its nonspecific presentation, the low sensitivity of smear microscopy in cerebrospinal fluid (CSF) samples and the slow growth of M. tuberculosis inculture.The GeneXpert MTB/RIF is an automated polymerase chainreaction (PCR) test with the advantage of detecting both M.tuberculosis complex and resistance to rifampicin within 2 hours in asingle-use cartridge test.This test is endorsed by the World Health Organization (WHO). WHO reportsugest the Xpert MTB/RIF had a sensitivity of 79.5% (95%confidence interval) and specificity of 98.6%compared to culture as a reference in detecting TB.Imaging with cerebral computed tomography (CT) and cerebral magnetic resonance imaging (MRI) has been part of diagnostic assessment,prognostication and management in TBM.The diagnosis of definite TBM was based on acid-fast bacilli (AFB) staining or mycobacterial culture, butthat needs a long time to wait for the results. A scoring systemwas adopted internationally as well as by the WHO todiagnose tuberculosis in childhood.
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