BACKGROUND/AIM Central nervous system tuberculosis (CNS-TB), a severe form of extrapulmonary tuberculosis presents with non specific symptom leading to delayed diagnosis and increased morbidity. This study compares different modalities of diagnosis of CNS-TB [Multiplex real-time PCR/ GeneXpert, TB culture, Ziehl-Neelsen staining( Z-N staining) and histopathology].
METHOD This is a cross sectional observational study conducted in the Department of Neuropathology from October 2016 to May 2019. Total 128 brain and spinal cases which were clinically suggestive of TB and operated were evaluated.
RESULT Granuloma, giant cell and necrosis were less evident in spinal TB compared to brain. GeneXpert and culture positivity were higher(100%) in tissue having poorly formed granuloma compared to well formed granuloma. Z-N stain has poor sensitivity (around 32%). Compared to culture GeneXpert was 100% sensitive and 96% specific in brain TB( detected from tissue) and 87% and 89% in spinal TB respectively.
CONCLUSION Combined together all these modalities provide a wholistic approach so that not a single case of tuberculosis is missed.
2. Ehlers S, Schaible UE. The granuloma in tuberculosis: dynamics of a host-pathogen collusion. Front Immunol. 2013 Jan 7;3:411.
3. Lay G, Poquet Y, Salek-Peyron P, Puissegur MP, et al. Langhans giant cells from M tuberculosis induced human granulomas cannot mediate mycobacterial uptake. J Pathol 2007;211:76–85.85.
4. Lighter J, Rigaud M. Diagnosing childhood tuberculosis: traditional and innovative modalities. Curr Probl Pediatr Adolesc Health Care, March 2009 61.
5. Verdon, R., S. Chevret, J. P. Laissy, and M. Wolff. 1996. Tuberculous meningitis in adults: review of 48 cases. Clin. Infect. Dis. 22:982–988.
6. Yeager H Jr, Lacy J, Smith LR, LeMaistre CA. Quantitative studies of mycobacterial populations in sputum and saliva. Am Rev Respir Dis 1967;95(6):998-1004.
7. Helb D, Jones M et al. Rapid Detection of Mycobacterium tuberculosis and Rifampin Resistance by Use of On-Demand, Near-Patient Technology.Journal of Clinical Microbiology Jan 2010, 48 (1) 229-237
8. Hunter R. L. Tuberculosis as a three-act play: A new paradigm for the pathogenesis of pulmonary tuberculosis. Tuberculosis (Edinb). 2016 March ; 97: 8–17. doi:10.1016/j.tube.2015.11.010.
9. Logani S, Lucas DR, Cheng JD, Ioachim HL, Adsay NV. Spindle cell tumors associated with mycobacteria in lymph nodes of HIV-positive patients: ‘Kaposi sarcoma with mycobacteria’ and ‘mycobacterial pseudotumor’. American Journal of Surgical Pathology, vol. 23, no. 6, pp. 656–661, 1999.
10. Velayati AA, Farnia P, Masjedi MR, Konstantinovich G. Morphological modification by tubercle bacilli: no time for denial. Journal of Infection in Developing Countries 2012:6(1):97–99.
11. Karimi S, Shamaei M, Pourabdollah M, Sadr M, Karbasi M, Kiani A, Bahadori M. Histopathological Findings in Immunohistological Staining of the Granulomatous Tissue Reaction Associated with Tuberculosis. Tuberc Res Treat. 2014;2014:858396.