Evaluation of GeneXpert MTB/RIF for Diagnosis of Tuberculous Meningitis

Medientyp: E-Artikel

Titel: Evaluation of GeneXpert MTB/RIF for Diagnosis of Tuberculous Meningitis

Beteiligte: Nhu, Nguyen Thi Quynh; Heemskerk, Dorothee; Thu, Do Dang Anh; Chau, Tran Thi Hong; Mai, Nguyen Thi Hoang; Nghia, Ho Dang Trung; Loc, Pham Phu; Ha, Dang Thi Minh; Merson, Laura; Thinh, Tran Thi Van; Day, Jeremy; Chau, Nguyen van Vinh; Wolbers, Marcel; Farrar, Jeremy; Caws, Maxine

Erschienen: American Society for Microbiology, 2014

Sprache: Englisch

DOI: 10.1128/jcm.01834-13

ISSN: 0095-1137; 1098-660X

Schlagwörter: Microbiology (medical)

Entstehung:

Anmerkungen:

Beschreibung: ABSTRACT Tuberculous meningitis (TBM) is the most severe form of tuberculosis. Microbiological confirmation is rare, and treatment is often delayed, increasing mortality and morbidity. The GeneXpert MTB/RIF test was evaluated in a large cohort of patients with suspected tuberculous meningitis. Three hundred seventy-nine patients presenting with suspected tuberculous meningitis to the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, between 17 April 2011 and 31 December 2012 were included in the study. Cerebrospinal fluid samples were tested by Ziehl-Neelsen smear, mycobacterial growth indicator tube (MGIT) culture, and Xpert MTB/RIF. Rifampin (RIF) resistance results by Xpert were confirmed by an MTBDR-Plus line probe assay and all positive cultures were tested by phenotypic MGIT drug susceptibility testing. Overall, 182/379 included patients (48.0%) were diagnosed with tuberculous meningitis. Sensitivities of Xpert, smear, and MGIT culture among patients diagnosed with TBM were 59.3% (108/182 [95% confidence interval {CI}, 51.8 to 66.5%]), 78.6% (143/182 [95% CI, 71.9 to 84.3%]) and 66.5% (121/182 [95% CI, 59.1 to 73.3%]), respectively. There was one false-positive Xpert MTB/RIF test (99.5% specificity). Four cases of RIF resistance (4/109; 3.7%) were identified by Xpert, of which 3 were confirmed to be multidrug-resistant (MDR) TBM and one was culture negative. Xpert MTB/RIF is a rapid and specific test for the diagnosis of tuberculous meningitis. The addition of a vortexing step to sample processing increased sensitivity for confirmed TBM by 20% ( P = 0.04). Meticulous examination of a smear from a large volume of cerebrospinal fluid (CSF) remains the most sensitive technique but is not practical in most laboratories. The Xpert MTB/RIF represents a significant advance in the early diagnosis of this devastating condition.

Zugangsstatus: Freier Zugang

Nur in Feld suchen:

Zuletzt gesuchte Begriffe: