scholarly journals Performance of Lipoarabinomannan Assay using Cerebrospinal fluid for the diagnosis of Tuberculous meningitis among HIV patients

2019 ◽  
Vol 4 ◽  
pp. 123 ◽  
Author(s):  
Richard Kwizera ◽  
Fiona V. Cresswell ◽  
Gerald Mugumya ◽  
Micheal Okirwoth ◽  
Enock Kagimu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Hospital Mortality ◽  
Tuberculous Meningitis ◽  
Diagnostic Performance ◽  
Poor Performance ◽  
Case Definition ◽  
Hiv Positive ◽  
Diagnostic Utility ◽  
Uniform Case ◽  
Mycobacteria Tuberculosis

Background: The diagnostic utility of the Mycobacteria tuberculosis lipoarabinomannan (TB-LAM) antigen lateral flow assay on cerebrospinal fluid (CSF) for the diagnosis of tuberculous meningitis (TBM) has not been extensively studied and the few published studies have conflicting results. Methods: Lumbar CSF from 59 HIV-positive patients with suspected TBM was tested with TB-LAM and Xpert MTB/Rif Ultra. The diagnostic performance of CSF TB-LAM was compared to positive CSF Xpert MTB/Rif Ultra (definite TBM) and a composite reference of probable or definite TBM according to the uniform case definition.  Results: Of 59 subjects, 12 (20%) had definite TBM and five (9%) had probable TBM. With reference to definite TBM, CSF TB-LAM assay had a diagnostic sensitivity of 33% and specificity of 96%. When compared to a composite reference of definite or probable TBM, the sensitivity was 24% and specificity was 95%. There were two false positive tests with TB-LAM (3+ grade). In-hospital mortality in CSF TB-LAM positive patients was 17% compared to 0% in those with definite TBM by Xpert MTB/Rif Ultra but negative LAM. Conclusions: Lumbar CSF TB-LAM has a poor performance in diagnosing TBM. Both urine TB-LAM and Xpert Ultra should be further investigated in the diagnosis of TBM.

scholarly journals Performance of Lipoarabinomannan Assay using Cerebrospinal fluid for the diagnosis of Tuberculous meningitis among HIV patients

2019 ◽  
Vol 4 ◽  
pp. 123 ◽  
Author(s):  
Richard Kwizera ◽  
Fiona V. Cresswell ◽  
Gerald Mugumya ◽  
Micheal Okirwoth ◽  
Enock Kagimu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Hospital Mortality ◽  
Tuberculous Meningitis ◽  
Diagnostic Performance ◽  
Poor Performance ◽  
Case Definition ◽  
Hiv Positive ◽  
Diagnostic Utility ◽  
Uniform Case ◽  
Mycobacteria Tuberculosis

Background: The diagnostic utility of the Mycobacteria tuberculosis lipoarabinomannan (TB-LAM) antigen lateral flow assay on cerebrospinal fluid (CSF) for the diagnosis of tuberculous meningitis (TBM) has not been extensively studied and the few published studies have conflicting results. Methods: Lumbar CSF from 59 HIV-positive patients with suspected TBM was tested with TB-LAM and Xpert MTB/Rif Ultra. The diagnostic performance of CSF TB-LAM was compared to positive CSF Xpert MTB/Rif Ultra (definite TBM) and a composite reference of probable or definite TBM according to the uniform case definition.  Results: Of 59 subjects, 12 (20%) had definite TBM and five (9%) had probable TBM. With reference to definite TBM, CSF TB-LAM assay had a diagnostic sensitivity of 33% and specificity of 96%. When compared to a composite reference of definite or probable TBM, the sensitivity was 24% and specificity was 95%. There were two false positive tests with TB-LAM (3+ grade). In-hospital mortality in CSF TB-LAM positive patients was 17% compared to 0% in those with definite TBM by Xpert MTB/Rif Ultra but negative LAM. Conclusions: Lumbar CSF TB-LAM has a poor performance in diagnosing TBM. Both urine TB-LAM and Xpert Ultra should be further investigated in the diagnosis of TBM.

scholarly journals EVALUATION OF DIAGNOSTIC PERFORMANCE OF GENEXPERT MTB IN CEREBROSPINAL FLUID FOR EARLY DIAGNOSIS OF TUBERCULOUS MENINGITIS

2019 ◽  
Vol 6 (33) ◽  
pp. 2253-2256
Author(s):  
Namita Mohapatra ◽  
Gurukurshna Mohapatra ◽  
Sankarsan Das ◽  
Choudhry Bijay Kumar Mohanty ◽  
Jigyansa Mohapatra
Keyword(s):  
Cerebrospinal Fluid ◽  
Early Diagnosis ◽  
Tuberculous Meningitis ◽  
Diagnostic Performance

Tuberculous meningitis: a uniform case definition for use in clinical research

2010 ◽  
Vol 10 (11) ◽  
pp. 803-812 ◽  
Author(s):  
Suzaan Marais ◽  
Guy Thwaites ◽  
Johan F Schoeman ◽  
M Estée Török ◽  
Usha K Misra ◽  
...  
Keyword(s):  
Clinical Research ◽  
Tuberculous Meningitis ◽  
Case Definition ◽  
Uniform Case

scholarly journals Fujifilm SILVAMP TB LAM assay on cerebrospinal fluid for the detection of tuberculous meningitis in HIV-infected adults

2021 ◽  
Author(s):  
Carson M Quinn ◽  
Enock Kagimu ◽  
Michael Okirworth ◽  
Ananta S Bangdiwala ◽  
Gerald Mugumya ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Case Definition ◽  
Ease Of Use ◽  
Lower Sensitivity ◽  
High Fatality Rate ◽  
Time To Treatment Initiation ◽  
Low Sensitivity ◽  
National Referral Hospital ◽  
Higher Sensitivity

Abstract Background Tuberculous meningitis (TBM) has a high fatality rate with inadequate diagnostic tests being a major contributor. The rollout of Xpert MTB/Rif and Xpert MTB/Rif Ultra (Xpert Ultra) have improved time-to-diagnosis with sensitivities similar to culture, yet test availability and sensitivity are inadequate. The TB lipoarabinomannan lateral flow assay (AlereLAM) offers ease of use, but its low sensitivity in cerebrospinal fluid (CSF) limits clinical utility for TBM. The Fujifilm SILVAMP TB LAM (FujiLAM) assay has excellent sensitivity in urine, but performance on cerebrospinal fluid is uncertain. Methods We conducted a prospective cohort study at Kiruddu National Referral Hospital in Kampala, Uganda enrolling patients suspected to have TB meningitis. CSF was tested using AlereLAM, Xpert Ultra, culture, and FujiLAM. Results were compared to two reference standards: probable and definite TBM, or definite TBM alone by the uniform TBM case definition. Results Of 101 patients enrolled (95/101 HIV-positive), 34 had definite TBM and 24 had probable TBM. FujiLAM sensitivity on CSF was 52% (30/58) for definite or probable TBM, compared to 55% (32/58) for Xpert Ultra. AlereLAM had lower sensitivity than FujiLAM in the subgroup of patients tested with both assays (14%, 4/28 vs. 50%,14/28; p<0.01). FujiLAM specificity was 98% (42/43) for patients without probable or definite TBM. Conclusions FujiLAM showed higher sensitivity than AlereLAM, with sensitivity potentially approaching that of Xpert Ultra. FujiLAM could improve time-to-treatment-initiation, especially in settings where the more technical Xpert Ultra system might not be feasible. Large confirmatory studies are needed.

Role of Cerebrospinal Fluid Shunting for Human Immunodeficiency Virus-positive Patients with Tuberculous Meningitis and Hydrocephalus

Neurosurgery ◽  
2000 ◽  
Vol 47 (3) ◽  
pp. 644-650
Author(s):  
Syed Sameer Nadvi ◽  
Narendra Nathoo ◽  
Ken Annamalai ◽  
James R. van Dellen ◽  
Ahmed I. Bhigjee
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Hiv Positive ◽  
Negative Group ◽  
Cd4 Counts ◽  
Positive Group ◽  
Immunodeficiency Virus ◽  
Cerebrospinal Fluid Shunting ◽  
Hiv Negative

ABSTRACT OBJECTIVE Tuberculous meningitis (TBM) and its complications continue to have devastating neurological consequences for patients. Budgetary constraints, especially in developing countries, have made it necessary to select patients for shunting who are likely to experience good recoveries. To date, the value of cerebrospinal fluid shunting for human immunodeficiency virus (HIV)-positive patients with TBM has not been clearly established. METHODS Thirty patients with TBM and hydrocephalus were prospectively evaluated. Coincidentally, one-half of the patients were HIV-positive. All patients underwent uniform treatment, including ventriculoperitoneal shunt placement and antituberculosis treatment. CD4 counts were measured for all patients. Outcomes were assessed at 1 month. RESULTS No complications related to shunt insertion were noted. The HIV-positive group fared poorly (death, 66.7%; poor outcome, 64.7%), compared with the HIV-negative group (death, 26.7%; poor outcome, 30.8%). Despite cerebrospinal fluid shunting, no patient in the HIV-positive group experienced a good recovery (Glasgow Outcome Scale score of 5). This is in contrast to the six patients (40%) in the HIV-negative group who, with the same treatment, experienced good recoveries (Glasgow Outcome Scale scores of 5) at discharge (P < 0.14). No patient (either HIV-positive or HIV-negative) who presented in TBM Grade 4 survived, whereas no HIV-positive patient who presented in TBM Grade 3 survived. A significant relationship was noted between CD4 counts and patient outcomes (P < 0.031). CONCLUSION In the absence of obvious clinical benefit, HIV-positive patients with TBM should undergo a trial of ventricular or lumbar cerebrospinal fluid drainage, and only those who exhibit significant neurological improvement should proceed to shunt surgery.

scholarly journals A Simple Microfluidic Assay for Diagnosing Tuberculous Meningitis in HIV-Uninfected Patients

2019 ◽  
Vol 57 (5) ◽  
Author(s):  
Joung Ha Park ◽  
Choong Eun Jin ◽  
Bonhan Koo ◽  
Ji-Soo Kwon ◽  
Hye Hee Cha ◽  
...  
Keyword(s):  
Tuberculous Meningitis ◽  
High Sensitivity ◽  
Tertiary Hospital ◽  
Case Definition ◽  
Reference Standards ◽  
Small Samples ◽  
Mycobacterial Culture ◽  
Immunodeficiency Virus ◽  
Uniform Case ◽  
Positive Results

ABSTRACTWe evaluated the diagnostic performance of asimple andlabel-free pathogen enrichment method using homobifunctionalimidoesters (HI) and amicrofluidic system, called the SLIM assay, followed by real-time PCR from cerebrospinal fluid (CSF) in human immunodeficiency virus (HIV)-uninfected patients with suspected tuberculous meningitis (TBM). Patients with suspected TBM were prospectively enrolled in a tertiary hospital in an intermediate tuberculosis (TB)-burden country during a 30-month period. TBM was classified according to the uniform case definition. Definite and probable TBM were regarded as the reference standards for TBM, and possible TBM and not-TBM as the reference standards for not-TBM. Of 72 HIV-uninfected patients with suspected TBM, 10 were diagnosed with definite (n = 2) and probable (n = 8) TBM by the uniform case definition. The sensitivity of the SLIM assay was 100% (95% confidence interval [CI], 69 to 100%) compared with definite or probable TBM, and it was superior to those of mycobacterial culture (20% [95% CI, 3 to 56%]) and the Xpert MTB/RIF assay (0% [95% CI, 0 to 31%]). Of 21 possible TBM and 41 not-TBM patients by the uniform case definition, 5 possible TBM and no not-TBM patients gave positive results in the SLIM assay. The specificity of the SLIM assay was 92% (95% CI, 82 to 97%; 5/62). We demonstrated that the SLIM assay had a very high sensitivity and specificity with small samples of 10 cases of definite or probable TBM. Further studies are needed to confirm this finding and to compare the SLIM assay with mycobacterial culture, Xpert MTB/RIF, and Xpert MTB/RIF Ultra assays in a larger prospective cohort of patients with suspected TBM, including both HIV-infected and HIV-uninfected cases.

Sign in / Sign up

Export Citation Format

Share Document