An Observational, Cross-sectional Study on Epidemiology and Clinical Spectrum of Tuberculous Meningitis in a Tertiary Care Hospital in Eastern India and Role of CSF CBNAAT for Rapid Diagnosis

  • Alapan Paul Senior Resident, Department of Neuro Medicine, Calcutta Medical College and Hospital.
  • Linkon Biswas Senior Resident, Department of Radiotherapy, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
  • Soumyasil Das Senior Resident, Department of General Medicine Malda Medical College and Hospital, Malda, West Bengal, India
  • Souvonik Mandal Assistant Professor, Department of General Medicine, Nilratan Sircar Medical College and Hospital Kolkata, West Bengal, India
  • Nirendra Mohan Biswas Professor (Retired), Department of General Medicine, Nilratan Sircar Medical College and Hospital Kolkata, West Bengal, India
Keywords: Tuberculous Meningitis, Epidemiology, CBNAAT, Prognostic Factors


Background: Tubercular meningitis (TBM) accounts for 70 to 80 percent of all neurological tuberculosis and is a major health issue in a country like India. But we don’t have adequate amount of data regarding the epidemiology and clinical pattern of TBM. In this study we aimed at exploring the epidemiological, clinical picture of TBM and compared different diagnostic modalities for early detection.

Methods and Materials: 50 patients with history and clinical features compatible with tuberculous meningitis were assessed through a detailed history and clinical examination followed by CSF study and an MRI of the brain.

Results: CSF study showed lymphocytic pleocytosis (92% cases) along with raised mean CSF protein 182.2±80.2 mg/dl (Mean ± SD) and reduced mean sugar 35.8 ±12.3mg/dl. CSF for AFB had least sensitivity (4%) but highest specificity (100%). CBNAAT showed both acceptable sensitivity (77%) and specificity (96%). CSF ADA had high sensitivity (85%) but low specificity (18%). Age >40 years, Altered consciousness, GCS<10, TBM stage 3, CSF glucose ≤30mg/dl& Presence of hydrocephalus were significantly associated with mortality from TBM (p-value<0.05).

Conclusion: CSF CBNAAT having acceptable sensitivity and specificity for diagnosis of TBM and can be used for early diagnosis as an alternative to CSF culture due to its rapidity and other bio-medical advantages.
Factors associated with adverse outcome can be used in future as components of risk prediction models.

How to cite this article:
Paul A, Biswas L, Das S, Mandal S, Biswas NM. An Observational, Cross-sectional Study on Epidemiology and Clinical Spectrum of Tuberculous Meningitis in a Tertiary Care Hospital in Eastern India and Role of CSF CBNAAT for Rapid Diagnosis. J Commun Dis. 2022;54(3):6-14.



Wang JT,Hung CC,Sheng WH,Wang JY,Chang SC,Luh KT.Prognosis of Tuberculosis meningitis in adults in

the era of modern anti-Tuberculosis chemotherapy.J Microbiol Immunol Infect.2002;35:215–22. [PubMed]

[Google Scholar]

Lu CH, Chang WN, Chang HW. The prognostic factors of adult Tuberculosis meningitis. Infection. 2001

Dec;29(6):299-304.[PubMed] [Google Scholar]

George EL, Iype T, Cherian A, Chandy S, Kumar A, Balakrishnan A, Vijayakumar K.Predictors of mortality

in patients with meningeal tuberculosis. Neurol India. 2012 Jan-Feb;60(1):18-22. [PubMed] [Google Scholar]

Thwaites GE, Duc Bang N, Huy Dung N, ThiQuy H, ThiTuongOanh D, Thi Cam Thoa N, Quang Hien N,

Tri Thuc N, Ngoc Hai N, Thi Ngoc Lan N, Ngoc Lan N, Hong Duc N, Ngoc Tuan V, HuuHiep C, Thi Hong Chau

T, Phuong Mai P, Thi Dung N, Stepniewska K, Simmons CP, White NJ, Tinh Hien T, Farrar JJ.The influence of

HIV infection on clinical presentation, response to treatment, and outcome in adults with Tuberculosis

meningitis. J Infect Dis. 2005 Dec;192(12):2134-41.[PubMed] [Google Scholar]

Ahuja GK, Mohan KK, Prasad K, Behari M. Diagnostic criteria for tuberculous meningitis and their validation.

Tuber Lung Dis. 1994 Apr;75(2):149-52.[PubMed] [Google Scholar]

Boyles TH, Thwaites GE. Appropriate use of the Xpert(R) MTB/RIF assay in suspected tuberculous meningitis.

Int J Tuberc Lung Dis. 2015 Mar;19(3):276-7.[PubMed] [Google Scholar]

Seth P, Ahuja GK, Bhanu NV, Behari M, Bhowmik S, Broor S, Dar L, Chakraborty M.Evaluation of polymerase

chain reaction for rapid diagnosis of clinically suspected Tuberculosis meningitis.Tuber Lung Dis. 1996

Aug;77(4):353-7.[PubMed] [Google Scholar]

Mir AW, Kirmani A, Eachkoti R, Siddiqi MA. Improved diagnosis of central nervous system tuberculosis by

MPB64-target PCR. Braz J Microbiol. 2008;39:209-13.[PubMed] [Google Scholar]

World Health Organization. Policy update: Xpert MTB/RIF assay for the diagnosis of pulmonary and

extra pulmonary TB in adults and children. Available Launch update

Accessed 7 June 2015.

Thwaites GE, Chau TT, Stepniewska K, Phu NH, Chuong LV, Sinh DX, White NJ, Parry CM, Farrar JJ. Diagnosis

of adult Tuberculosis meningitis by use of clinical and laboratory features.Lancet. 2002 Oct;360(9342):1287-

[PubMed] [Google Scholar]

Marais S, Thwaites G, Schoeman JF, Török ME, Misra UK, Prasad K, Donald PR, Wilkinson RJ, Marais BJ.

Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis. 2010

Nov;10(11):803-12.[PubMed] [Google Scholar]

Christensen AS, Andersen AB, Thomsen VO, Andersen PH, JohansenIS. Tuberculosis meningitis in Denmark: a

review of 50 cases. BMCInfect Dis.2011;11:47.[PubMed] [Google Scholar]

Sarkar DN, Hossain MI, Shoab AK, Quraishi FA. Presentation of tuberculous meningitis patients: Study

of 30 cases. Medicine Today. 2013 Aug;25(1):32-5. [Google Scholar]

Sharma HK, Gupta SK. Tuberculous meningitis- A clinicoradiological study. JK Science. 2013;15:198-201.[Google Scholar]

Aher A, Paithankar M, Bhurke B. Study of central nervous system tuberculosis. J Assoc Physicians India.

;66(1):41-4.[PubMed] [Google Scholar]

Salekeen S, Mahmood K, Naqvi IH, and Baig MY, Akhter ST, Abbasi A. Clinical course, complications and predictors of mortality in patients with tuberculous meningitis--an experience of fifty two cases at Civil Hospital Karachi, Pakistan. J Pak Med Assoc. 2013;63(5):563-7. [PubMed] [Google Scholar]

GargRK.Tuberculosis of the central nervous system. PostgradMedJ.1999;75:133-40.[Google Scholar]

Feng GD, Shi M, Ma L, Chen P, Wang BJ, Zhang M, Chang XL, Su XC, Yang YN, Fan XH, Dai W, Liu TT, He Y, Bian T, Duan LX, Li JG, Hao XK, Liu JY, Xue X, Song YZ, Wu HQ, Niu GQ, Zhang L, Han CJ, Lin H, Lin ZH, Liu JJ, Jian Q,

Zhang JS, Tian Y, Zhou BY, Wang J, Xue CH, Han XF, Wang JF, Wang SL, Thwaites GE, Zhao G.Diagnostic accuracy

of intracellular mycobacterium tuberculosis detection for tuberculous meningitis. Am J Respir Crit Care Med.

Feb;189(4):475-81.[PubMed] [Google Scholar]

Gupta BK, Bharat A, Debapriya B, Baruah H. Adenosine deaminase levels in CSF of tuberculosis meningitis

patients. J Clin Med Res. 2010 Oct;2(5):220-4.[PubMed] [Google Scholar]

Heemskerk D, Caws M, Marais B, Farrar J.Tuberculosis in Adults and Children. London: Springer; 2015.

Wellcome Trust–Funded Monographs and Book Chapters.[PubMed] [Google Scholar]

Patel VB, Theron G, Lenders L, Matinyena B, Connolly C, Singh R, Coovadia Y, Ndung’u T, Dheda K.Diagnostic

accuracy of quantitative PCR (XpertMTB/RIF) for tuberculous meningitis in a high burden setting: a

prospective study. PLoS Med. 2013 Oct;10(10):e1001536. [PubMed] [Google Scholar]

Nhu NT, Heemskerk D, Thu do DA, Chau TT, Mai NT, Nghia HD, Loc PP, Ha DT, Merson L, Thinh TT, Day J,

Chau Nv, Wolbers M, Farrar J, Caws M. Evaluation of GeneXpertMTB/RIF for diagnosis of tuberculous

meningitis.J Clin Microbiol. 2014 Jan;52(1):226-33. [PubMed] [Google Scholar]

Sheu JJ, Yuan RY, Yang CC. Predictors for outcome and treatment delay in patients with Tuberculosis

meningitis.Am J Med Sci. 2009 Aug;338(2):134-9. [PubMed] [Google Scholar]

Yasar KK, Pehlivanoglu F, Sengoz G. Predictors of mortality in tuberculous meningitis: a multivariate

analysis of 160 cases. Int J Tuberc Lung Dis. 2010 Oct;14(10):1330-5. [PubMed] [Google Scholar]