Xpert MTB/RIF Ultra for the Diagnosis of Tuberculous Meningitis: A Small Step Forward
Donovan J., Cresswell FV., Thuong NTT., Boulware DR., Thwaites GE., Bahr NC., Aarnoutse RE., Anderson STB., Bahr NC., Bang ND., Boulware DR., Boyles T., te Brake LHM., Chandra S., Chow FC., Cresswell FV., van Crevel R., Davis AG., Dian S., Donovan J., Dooley KE., Figaji A., Ganiem AR., Garg RK., Gibb DM., Hamers RL., Hiep NTT., Imran D., Imron A., Jain SK., Jain SK., Kalita J., Kumar R., Kumar V., van Laarhoven A., Lai RP-J., Manesh A., Marais S., Mave V., Meintjes G., Meya DB., Misra UK., Modi M., Ordonez AA., Phu NH., Pradhan S., Prasad K., Proust AM., Ramakrishnan L., Rohlwink U., Ruslami R., Schoeman JF., Seddon JA., Sharma K., Siddiqi O., Solomons RS., Thuong NTT., Thwaites GE., van Toorn R., Tucker EW., Wasserman SA., Wilkinson RJ., Aarnoutse RE., Anderson STB., Bahr NC., Bang ND., Boulware DR., Boyles T., te Brake LHM., Chandra S., Chow FC., Cresswell FV., van Crevel R., Davis AG., Dian S., Donovan J., Dooley KE., Figaji A., Ganiem AR., Garg RK., Gibb DM., Hamers RL., Hiep NTT., Imran D., Imron A., Jain SK., Jain SK., Kalita J., Kumar R., Kumar V., van Laarhoven A., Lai RP-J., Manesh A., Marais S., Mave V., Meintjes G., Meya DB., Misra UK., Modi M., Ordonez AA., Phu NH., Pradhan S., Prasad K., Proust AM., Ramakrishnan L., Rohlwink U., Ruslami R., Schoeman JF., Seddon JA., Sharma K., Siddiqi O., Solomons RS., Thuong NTT., Thwaites GE., van Toorn R., Tucker EW., Wasserman SA., Wilkinson RJ.
AbstractThe 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.