학술논문
Xpert MTB/RIF Ultra for the Diagnosis of Tuberculous Meningitis: A Small Step Forward
Document Type
article
Author
Donovan, Joseph; Cresswell, Fiona V; Thuong, Nguyen Thuy Thuong; Boulware, David R; Thwaites, Guy E; Bahr, Nathan C; Aarnoutse, Rob E; Anderson, Suzanne TB; Bang, Nguyen D; Boyles, Tom; te Brake, Lindsey HM; Chandra, Satish; Chow, Felicia C; van Crevel, Reinout; Davis, Angharad G; Dian, Sofiati; Dooley, Kelly E; Figaji, Anthony; Ganiem, A Rizal; Garg, Ravindra Kumar; Gibb, Diana M; Hamers, Raph L; Hiep, Nguyen TT; Imran, Darma; Imron, Akhmad; Jain, Sanjay K; Jain, Sunil K; Kalita, Jayantee; Kumar, Rashmi; Kumar, Vinod; van Laarhoven, Arjan; Lai, Rachel P-J; Manesh, Abi; Marais, Suzaan; Mave, Vidya; Meintjes, Graeme; Meya, David B; Misra, Usha K; Modi, Manish; Ordonez, Alvaro A; Phu, Nguyen H; Pradhan, Sunil; Prasad, Kameshwar; Proust, Alize M; Ramakrishnan, Lalita; Rohlwink, Ursula; Ruslami, Rovina; Schoeman, Johannes F; Seddon, James A; Sharma, Kusum; Siddiqi, Omar; Solomons, Regan S; Thuong, Nguyen TT; van Toorn, Ronald; Tucker, Elizabeth W; Wasserman, Sean A; Wilkinson, Robert J
Source
Clinical Infectious Diseases. 71(8)
Subject
Language
Abstract
The delayed diagnosis of tuberculous meningitis (TBM) leads to poor outcomes, yet the current diagnostic methods for identifying Mycobacterium tuberculosis in cerebrospinal fluid (CSF) are inadequate. The first comparative study of the new GeneXpert MTB/RIF Ultra (Xpert Ultra) for TBM diagnosis suggested increased sensitivity of Xpert Ultra. Two subsequent studies have shown Xpert Ultra has improved sensitivity, but has insufficient negative predictive value to exclude TBM. Collecting and processing large volumes of CSF for mycobacterial testing are important for optimal diagnostic test performance. But clinical, radiological, and laboratory parameters remain essential for TBM diagnosis and empiric therapy is often needed. We therefore caution against the use of Xpert Ultra as a single diagnostic test for TBM; it cannot be used to "rule out" TBM.