• Ping Chen, Ming Shi, Guo-Dong Feng, Jia-Yun Liu, Bing-Ju Wang, Xiao-Dan Shi, Lei Ma, Xue-Dong Liu, Yi-Ning Yang, Wen Dai, Ting-Ting Liu, Ying He, Jin-Ge Li, Xiao-Ke Hao, and Gang Zhao.
• Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi’an, Shaanxi 710032, China.
• J. Clin. Microbiol. 2012 Apr 1;50(4):1166-70.

AbstractTuberculous meningitis leads to a devastating outcome, and early diagnosis and rapid chemotherapy are vital to reduce morbidity and mortality. Since Mycobacterium tuberculosis is a kind of cytozoic pathogen and its numbers are very few in cerebrospinal fluid, detecting M. tuberculosis in cerebrospinal fluid from tuberculous meningitis patients is still a challenge for clinicians. Ziehl-Neelsen stain, the current feasible microbiological method for the diagnosis of tuberculosis, often needs a large amount of cerebrospinal fluid specimen but shows a low detection rate of M. tuberculosis. Here, we developed a modified Ziehl-Neelsen stain, involving cytospin slides with Triton processing, in which only 0.5 ml of cerebrospinal fluid specimens was required. This method not only improved the detection rate of extracellular M. tuberculosis significantly but also identified intracellular M. tuberculosis in the neutrophils, monocytes, and lymphocytes clearly. Thus, our modified method is more effective and sensitive than the conventional Ziehl-Neelsen stain, providing clinicians a convenient yet powerful tool for rapidly diagnosing tuberculous meningitis.

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