학술논문
The microbiological diagnosis of tuberculous meningitis: results of Haydarpasa-1 study
Document Type
Academic Journal
Author
Erdem, H.; Ozturk-Engin, D.; Elaldi, N.; Gulsun, S.; Sengoz, G.; Crisan, A.; Johansen, I. S.; Inan, A.; Nechifor, M.; Al-Mahdawi, A.; Civljak, R.; Ozguler, M.; Savic, B.; Ceran, N.; Cacopardo, B.; Inal, A. S.; Namiduru, M.; Dayan, S.; Kayabas, U.; Parlak, E.; Khalifa, A.; Kursun, E.; Sipahi, O. R.; Yemisen, M.; Akbulut, A.; Bitirgen, M.; Dulovic, O.; Kandemir, B.; Luca, C.; Parlak, M.; Stahl, J. P.; Pehlivanoglu, F.; Simeon, S.; Ulu-Kilic, A.; Yasar, K.; Yilmaz, G.; Yilmaz, E.; Beovic, B.; Catroux, M.; Lakatos, B.; Sunbul, M.; Oncul, O.; Alabay, S.; Sahin-Horasan, E.; Kose, S.; Shehata, G.; Andre, K.; Alp, A.; Ćosić, G.; Cem Gul, H.; Karakas, A.; Chadapaud, S.; Hansmann, Y.; Harxhi, A.; Kirova, V.; Masse-Chabredier, I.; Oncu, S.; Sener, A.; Tekin, R.; Deveci, O.; Karabay, O.; Agalar, C.; Allerberger, F.
Source
Clinical Microbiology & Infection. Oct 01, 2014 20(10):O600-O608
Subject
Language
English
ISSN
1198-743X
Abstract
ABSTRACT: We aimed to provide data on the diagnosis of tuberculous meningitis (TBM) in this largest case series ever reported. The Haydarpasa-1 study involved patients with microbiologically confirmed TBM in Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria and Turkey between 2000 and 2012. A positive culture, PCR or Ehrlich–Ziehl–Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) was mandatory for inclusion of meningitis patients. A total of 506 TBM patients were included. The sensitivities of the tests were as follows: interferon-γ release assay (Quantiferon TB gold in tube) 90.2%, automated culture systems (ACS) 81.8%, Löwenstein Jensen medium (L-J) 72.7%, adenosine deaminase (ADA) 29.9% and EZNs 27.3%. CSF-ACS was superior to CSF L-J culture and CSF-PCR (p <0.05 for both). Accordingly, CSF L-J culture was superior to CSF-PCR (p <0.05). Combination of L-J and ACS was superior to using these tests alone (p <0.05). There were poor and inverse agreements between EZNs and L-J culture (κ = −0.189); ACS and L-J culture (κ = −0.172) (p <0.05 for both). Fair and inverse agreement was detected for CSF-ADA and CSF-PCR (κ = −0.299, p <0.05). Diagnostic accuracy of TBM was increased when both ACS and L-J cultures were used together. Non-culture tests contributed to TBM diagnosis to a degree. However, due to the delays in the diagnosis with any of the cultures, combined use of non-culture tests appears to contribute early diagnosis. Hence, the diagnostic approach to TBM should be individualized according to the technical capacities of medical institutions particularly in those with poor resources.