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

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.

Download Full-text

Lumbar Cerebrospinal Fluid Evolution in Childhood Tuberculous Meningitis

Journal of Child Neurology ◽

10.1177/0883073818785553 ◽

2018 ◽

Vol 33 (11) ◽

pp. 700-707 ◽

Cited By ~ 3

Author(s):

Madelein Grobbelaar ◽

Ronald van Toorn ◽

Regan Solomons

Keyword(s):

South Africa ◽

Cerebrospinal Fluid ◽

Early Diagnosis ◽

Tuberculous Meningitis ◽

Protein Concentration ◽

Initial Increase ◽

Gradual Decline ◽

Lumbar Cerebrospinal Fluid ◽

Normal Variability ◽

Fluid Parameters

As early diagnosis of childhood tuberculous meningitis cannot rely on mycobacterial confirmation, clinical, cerebrospinal fluid and neuroimaging features are essential. We aimed to describe the evolution of serially analyzed lumbar cerebrospinal fluid parameters. We performed a retrospective observational study including children <13 years with suspected tuberculous meningitis at Tygerberg Hospital, Cape Town, South Africa. Cerebrospinal fluid parameters at admission and weeks 1, 2, and 3 were analyzed. Of 318 children with suspected tuberculous meningitis, 53 (17%) had “definite” tuberculous meningitis and 265 (83%) “probable” tuberculous meningitis. Longitudinal clustering revealed 3 distinct profiles, with 1 group atypically demonstrating initial increase in lymphocyte count, neutrophil count, and protein concentration. The decreasing cerebrospinal fluid glucose trend remained uniform among all groups. A gradual decline in cerebrospinal fluid lymphocyte, neutrophil and protein count, and rise in cerebrospinal fluid glucose concentration is expected; however, normal variability exists.

Download Full-text

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

Wellcome Open Research ◽

10.12688/wellcomeopenres.15389.2 ◽

2019 ◽

Vol 4 ◽

pp. 123 ◽

Cited By ~ 1

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.

Download Full-text