Evaluation of the GeneXpert MTB/RIF in patients with presumptive tuberculous meningitis.

Autor: Metcalf T; Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.; Northern Pacific Fogarty Global Health Fellowship Program, National Institutes of Health, University of Washington, Seattle, Washington, United States of America., Soria J; Northern Pacific Fogarty Global Health Fellowship Program, National Institutes of Health, University of Washington, Seattle, Washington, United States of America.; Department of Tropical and Infectious Diseases, Hospital Nacional Dos de Mayo, Lima, Peru., Montano SM; US Naval Medical Research Unit No. 6, Callao, Peru., Ticona E; Department of Tropical and Infectious Diseases, Hospital Nacional Dos de Mayo, Lima, Peru., Evans CA; Section of Infectious Diseases & Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, United Kingdom.; Innovation for Health & Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru., Huaroto L; Department of Tropical and Infectious Diseases, Hospital Nacional Dos de Mayo, Lima, Peru., Kasper M; US Naval Medical Research Unit No. 6, Callao, Peru., Ramos ES; Innovation for Health & Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru., Mori N; Northern Pacific Fogarty Global Health Fellowship Program, National Institutes of Health, University of Washington, Seattle, Washington, United States of America., Jittamala P; Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand., Chotivanich K; Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand., Chavez IF; Department of Tropical Hygiene (Biomedical and Health Informatics), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand., Singhasivanon P; Department of Tropical Hygiene (Biomedical and Health Informatics), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand., Pukrittayakamee S; Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand., Zunt JR; Department of Neurology, University of Washington, Seattle, Washington, United States of America.; Department of Global Health, University of Washington, Seattle, Washington, United States of America.; Department of Medicine, University of Washington, Seattle, Washington, United States of America.; Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2018 Jun 18; Vol. 13 (6), pp. e0198695. Date of Electronic Publication: 2018 Jun 18 (Print Publication: 2018).
DOI: 10.1371/journal.pone.0198695
Abstrakt: Background: Meningitis caused by Mycobacterium tuberculosis is a major cause of morbidity and mortality worldwide. We evaluated the performance of cerebrospinal fluid (CSF) testing with the GeneXpert MTB/RIF assay versus traditional approaches for diagnosing tuberculosis meningitis (TBM).
Methods: Patients were adults (n = 37) presenting with suspected TBM to the Hospital Nacional Dos de Mayo, Lima, Peru, during 12 months until 1st January 2015. Each participant had a single CSF specimen that was divided into aliquots that were concurrently tested for M. tuberculosis using GeneXpert, Ziehl-Neelsen smear and culture on solid and liquid media. Drug susceptibility testing used Mycobacteria Growth Indicator Tube (MGIT 960) and the proportions method.
Results: 81% (30/37) of patients received a final clinical diagnosis of TBM, of whom 63% (19/30, 95% confidence intervals, CI: 44-80%) were HIV-positive. 22% (8/37, 95%CI: 9.8-38%), of patients had definite TBM. Because definite TBM was defined by positivity in any laboratory test, all laboratory tests had 100% specificity. Considering the 30 patients who had a clinical diagnosis of TBM: diagnostic sensitivity was 23% (7/30, 95%CI: 9.9-42%) for GeneXpert and was the same for all culture results combined; considerably greater than 7% (2/30, 95%CI: 0.82-22%) for microscopy; whereas all laboratory tests had poor negative predictive values (20-23%). Considering only the 8 patients with definite TBM: diagnostic sensitivity was 88% (7/8, 95%CI: 47-100%) for GeneXpert; 75% (6/8, 95%CI: 35-97%) for MGIT culture or LJ culture; 50% (4/8, 95%CI 16-84) for Ogawa culture and 25% (2/8, 95%CI: 3.2-65%) for microscopy. GeneXpert and microscopy provided same-day results, whereas culture took 20-56 days. GeneXpert provided same-day rifampicin-susceptibility results, whereas culture-based testing took 32-71 days. 38% (3/8, 95%CI: 8.5-76%) of patients with definite TBM with data had evidence of drug-resistant TB, but 73% (22/30) of all clinically diagnosed TBM (definite, probable, and possible TBM) had no drug-susceptibility results available.
Conclusions: Compared with traditional culture-based methods of CSF testing, GeneXpert had similar yield and faster results for both the detection of M. tuberculosis and drug-susceptibility testing. Including use of the GeneXpert has the capacity to improve the diagnosis of TBM cases.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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