Xpert MTB/RIF Ultra for the Diagnosis of Tuberculous Meningitis: A Small Step Forward
Joseph Donovan, Fiona V Cresswell, Nguyễn Thụy Thương Thương, David R. Boulware, Guy Thwaites, Nathan C. Bahr, Rob E. Aarnoutse, Suzanne T. Anderson, Nathan C. Bahr, Nguyen Duc Bang, David R. Boulware, Tom Boyles, Lindsey H. M. te Brake, Satish Chandra, Felicia C. Chow, Fiona V Cresswell, Reinout van Crevel, Angharad Davis, Sofiati Dian, Joseph Donovan, Kelly E. Dooley, Anthony Figaji, Ahmad Rizal Ganiem, Ravindra Kumar Garg, Diana M. Gibb, Raph L Hamers, Nguyen Thi Thu Hiep, Darma Imran, Akhmad Imron, Sanjay K. Jain, Sunil K. Jain, Jayantee Kalita, Rashmi Kumar, Vinod Kumar, Arjan van Laarhoven, Rachel Lai, Abi Manesh, Suzaan Marais, Vidya Mave, Graeme Meintjes, David B. Meya, U. K. Misra, Manish Modi, Alvaro A. Ordoñez, Nguyen Hoan Phu, Sunil Pradhan, Kameshwar Prasad, Alizé Proust, Lalita Ramakrishnan, Ursula K. Rohlwink, Rovina Ruslami, J. F. Schoeman, James A. Seddon, Kusum Sharma, Omar K. Siddiqi, Regan Solomons, Nguyễn Thụy Thương Thương, Guy Thwaites, Ronald van Toorn, Elizabeth W. Tucker, Sean Wasserman, Robert J. Wilkinson, Rob E. Aarnoutse, Suzanne T. Anderson, Nathan C. Bahr, Nguyen Duc Bang, David R. Boulware, Tom Boyles, Lindsey H. M. te Brake, Satish Chandra, Felicia C. Chow, Fiona V Cresswell, Reinout van Crevel, Angharad Davis, Sofiati Dian, Joseph Donovan, Kelly E. Dooley, Anthony Figaji, Ahmad Rizal Ganiem, Ravindra Kumar Garg, Diana M. Gibb, Raph L Hamers, Nguyen Thi Thu Hiep, Darma Imran, Akhmad Imron, Sanjay K. Jain, S. K. Jain, Jayantee Kalita, Rashmi Kumar, Vinod Kumar, Arjan van Laarhoven, Rachel Lai, Abi Manesh, Suzaan Marais, Vidya Mave, Graeme Meintjes, David B. Meya, U. K. Misra, Manish Modi, Alvaro A. Ordoñez
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.