Validation of the Uniform Case Definition Criteria for Differentiating Tuberculous Meningitis, Viral Meningitis, and Bacterial Meningitis in Adults

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.

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Laboratory diagnosis of tuberculous meningitis in human immunodeficiency virus–seropositive patients: Correlation with the uniform case definition

Southern African Journal of Infectious Diseases ◽

10.4102/sajid.v35i1.135 ◽

2020 ◽

Vol 35 (1) ◽

Author(s):

Mohammed Mitha ◽

Melendhran Pillay ◽

Julie Y. Moodley ◽

Yusentha Balakrishna ◽

Nathlee Abbai ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Tuberculous Meningitis ◽

Laboratory Diagnosis ◽

Case Definition ◽

Immunodeficiency Virus ◽

Uniform Case

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The association between serum sodium levels and tuberculous meningitis compared to viral and bacterial meningitis: Multicenter retrospective cohort study

10.21203/rs.3.rs-272913/v1 ◽

2021 ◽

Author(s):

Seunghee Na ◽

Taewon Kim ◽

In-Uk Song ◽

Sung-Woo Chung ◽

Seong-Hoon Kim ◽

...

Keyword(s):

Differential Diagnosis ◽

Bacterial Meningitis ◽

Tuberculous Meningitis ◽

Serum Sodium ◽

Retrospective Cohort ◽

Total Population ◽

Viral Meningitis ◽

Lower Serum ◽

Cross Sectional ◽

Additional Information

Abstract We evaluated the association between hyponatremia and tuberculous meningitis (TBM) in hopes of providing additional information for the differential diagnosis of TBM from other types of infectious meningitis, especially from viral meningitis (VM). Cross-sectional and longitudinal data involving 5,026 participants more than 18 years of age were analyzed in the total population and the propensity-matched population. The initial and lowest sodium levels and longitudinal changes in TBM, VM, and bacterial meningitis (BM) patients were compared. The initial serum sodium levels were significantly lower in the TBM patients than in the VM and BM patients (136.9 ± 5.9 vs. 139.0 ± 3.1, p < 0.001 for TBM vs. VM, and 138.3 ± 4.7 mmol/L and p < 0.001 for TBM vs. BM) and it dropped significantly more steeply to lower levels in both the TBM and BM patients compared to the VM patients. Consequently, the lowest serum sodium levels were in the order of the TBM < BM < VM patients, which were also statistically significant in all subgroups. (131.8 ± 6.4, 133.1 ± 5.1, 137.4 ± 3.7, respectively, p < 0.001). The participants with lower serum sodium levels were more likely to have a diagnosis of TBM rather than VM, and this association was more pronounced for the lowest sodium levels than the initial sodium levels (OR 8.4 (95% CI: 4.5–15.8, p < 0.001)). The baseline and longitudinal evaluation of serum sodium levels can provide supportive information for the differential diagnosis of TBM from VM or BM.

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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.

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Spectrum of central nervous system infections in neurosciences hospital in two years : a retrospective study

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v16i1.197 ◽

2020 ◽

Vol 16 (1) ◽

pp. 67-73

Author(s):

Aiyar Shakir Jawad

Keyword(s):

Spinal Cord ◽

Bacterial Meningitis ◽

Tuberculous Meningitis ◽

Viral Encephalitis ◽

Viral Meningitis ◽

Preschool Age ◽

Clinical Aspects ◽

High Morbidity ◽

Focal Neurological Deficit ◽

Cns Infections

Background :Infectious disorders in general have high morbidity and mortality.. CNS infections include many disorders like bacterial meningitis, tuberculous and other subacute and chronic meningitis, viral meningitis, cerebral abscess, spinal cord infections, and others.Objective: To assess our locality about prevalence of CNS infections , to have more awareness regarding CNS infections, and to try to find the proper way to reduce their prevalence and to treat them in appropriate way.Method :We revised the records of all the cases of CNS infections excluding cases of spinal cord infections who were admitted in the wards of neuroscience hospital over the previous two years ( from July/2010 to June 2012 ),those were 132 cases.Seasonal incidenceand other clinical aspects and other parameters like age , sex, , fever are extracted and recordedResults: The most common CNS infections in sequence from the most to the least were bacterial meningitis, viral encephalitis, tuberculous meningitis, viral meningitis, and cerebral abscess.The most common age group which is affected by CNS infections was below 10 years.Males are affected more than females taking in consideration all types of infection.P values were statistically significant for age, fever, signs of meningeal irritation, focal neurological deficit, and seizures.Conclusion : The total rate of admission of CNS infections in our series was lower than other study.The most frequent type of CNS infections was bacterial meningitis which is the same as most of the studies.Males are affected more than females in our study in all types of CNS infections, this was approximate to other studies except for tuberculous meningitis.Bacterial meningitis and viral encephalitis were more common in preschool children in our study.Fever rate in bacterial and tuberculous meningitis was different from other studies.Seizure rate in bacterial meningitis and viral encephalitis was approximate to other results.Rate of focal deficit in viral encephalitis and tuberculous meningitis was different from other studies.Rate of CSF protein elevation in all CNS infections was approximate to other studies.Rate of hypoglycorrhachia was different from other studies only in tuberculous meningitis.CSF pleocytosis was approximate to other studies in all types of CNS infections.The two most common types of CNS infections , bacterial meningitis and viral encephalitis, are more common in preschool age groups.

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

Journal of Clinical Microbiology ◽

10.1128/jcm.01975-18 ◽

2019 ◽

Vol 57 (5) ◽

Cited By ~ 1

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.

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The association between serum sodium level and tuberculous meningitis compared with viral and bacterial meningitis

Scientific Reports ◽

10.1038/s41598-021-90358-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Seunghee Na ◽

Taewon Kim ◽

In-Uk Song ◽

Sung-Woo Chung ◽

Seong-Hoon Kim ◽

...

Keyword(s):

Differential Diagnosis ◽

Bacterial Meningitis ◽

Tuberculous Meningitis ◽

Serum Sodium ◽

Sodium Level ◽

Total Population ◽

Serum Sodium Level ◽

Viral Meningitis ◽

Cross Sectional ◽

Additional Information

AbstractWe evaluated the association between hyponatremia and tuberculous meningitis (TBM) with the aim of providing additional information for differential diagnosis from other types of infectious meningitis, especially viral meningitis (VM). Cross-sectional and longitudinal data involving 5026 participants older than 18 years were analyzed in the total population and a propensity-matched population. The initial and lowest sodium levels and longitudinal changes in TBM, bacterial meningitis (BM), and VM patients were compared. Participants in the TBM group were enrolled when they were diagnosed as possible, probable, or definite TBM according to the Marais’ criteria. The initial serum sodium level was significantly lower in TBM patients than in BM and VM patients (136.9 ± 5.9 vs. 138.3 ± 4.7 mmol/L, p < 0.001 for TBM vs. BM, and 139.0 ± 3.1, p < 0.001 for TBM vs. VM), and it decreased significantly more steeply to lower levels in both the TBM and BM patients compared with VM patients. The lowest serum sodium level was in the order of TBM < BM < VM patients, and the change was statistically significant in all subgroups (131.8 ± 6.4, 133.1 ± 5.1, 137.4 ± 3.7, respectively, p < 0.001). Participants with lower serum sodium level were more likely to have a diagnosis of TBM rather than VM, and this association was more pronounced for the lowest sodium level than the initial sodium level [OR 4.6 (95% CI 2.4–8.8, p < 0.001)]. These findings indicate that baseline and longitudinal evaluation of serum sodium level can provide information for differential diagnosis of TBM from BM or VM.

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