Diagnostic characteristics of Xpert MTB/RIF assay for the diagnosis of tuberculous meningitis and rifampicin resistance in Southern Brazil

Autor: Sérgio Monteiro de Almeida, José Henrique Carvalho, Keite da Silva Nogueira, Laura Lúcia Cogo, Gislene Maria Botão Kussen
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Central Nervous System
medicine.medical_specialty
Tuberculosis
Sistema Nervoso Central
Neurosciences. Biological psychiatry. Neuropsychiatry
Rifampicin resistance
Diagnostic tools
urologic and male genital diseases
Sensitivity and Specificity
Imaging data
Likelihood ratios in diagnostic testing
Gastroenterology
Polymerase Chain Reaction
Tuberculous meningitis
Mycobacterium tuberculosis
03 medical and health sciences
0302 clinical medicine
Internal medicine
Diagnosis
medicine
Humans
030212 general & internal medicine
0303 health sciences
biology
030306 microbiology
business.industry
Diagnóstico
biology.organism_classification
medicine.disease
bacterial infections and mycoses
Neurology
Tuberculose Meníngea
Tuberculosis
Meningeal
Neurology (clinical)
Rifampin
business
Brazil
Rifampicin
RC321-571
medicine.drug
Reação em Cadeia da Polimerase
Zdroj: Arquivos de Neuro-Psiquiatria, Volume: 78, Issue: 11, Pages: 700-707, Published: 14 DEC 2020
Arquivos de Neuro-Psiquiatria v.78 n.11 2020
Arquivos de neuro-psiquiatria
Academia Brasileira de Neurologia
instacron:ABNEURO
Arquivos de Neuro-Psiquiatria
Popis: Background: The timely diagnosis of tuberculous meningitis (TBM) is challenging. Molecular diagnostic tools are necessary for TBM, particularly in low- and middle-income countries. Objectives: We aimed to calculate the diagnostics characteristics of Xpert MTB/RIF for the detection of Mycobacterium tuberculosis in the cerebrospinal fluid (CSF) and the frequency of rifampicin (RIF)-resistance in the CSF samples. Methods: A total of 313 consecutive CSF samples were studied and categorized into TBM definite, probable, possible, or not TBM cases based on the clinical, laboratory, and imaging data. Results: For the definite TBM cases (n=7), the sensitivity, specificity, efficiency, and positive likelihood ratio were 100, 97, 97, and 38%, respectively. However, for the TBM definite associated with the probable cases (n=24), the sensitivity decreased to 46%. All CSF samples that were Xpert MTB/RIF-positive were RIF susceptible. Conclusion: Xpert MTB/RIF showed high discriminating value among the microbiology-proven TBM cases, although the values for the probable and possible TBM cases were reduced. Xpert MTB/RIF contributes significantly to the diagnosis of TBM, mainly when coupled with the conventional microbiological tests and clinical algorithms. RESUMO Introdução: O diagnóstico da meningite tuberculosa (TBM) é desafiador. Ferramentas de diagnóstico molecular são necessárias para esse diagnóstico, particularmente em países de baixa e média renda. Objetivos: Calcular as características diagnósticas do Xpert MTB/RIF para a detecção de Mycobacterium tuberculosis no líquido cefalorraquidiano (LCR) e a frequência de resistência à rifampicina (RIF) nas amostras do LCR. Métodos: Um total de 313 amostras consecutivas de LCR foram estudadas e categorizadas em casos de TBM definida, provável, possível ou não TBM, com base nos dados clínicos, laboratoriais e de imagem. Resultados: Para os casos definidos de TBM (n=7), sensibilidade, especificidade, eficiência e razão de verossimilhança positiva foram de 100, 97, 97 e 38%, respectivamente. No entanto, para os casos de TBM definidos associados aos prováveis (n=24), a sensibilidade diminuiu para 46%. Todas as amostras de LCR que foram positivas para Xpert MTB/RIF foram suscetíveis a RIF. Conclusão: O Xpert MTB/RIF mostrou alto valor discriminante entre os casos TBM comprovados por microbiologia, porém o valor nos casos prováveis e possíveis de TBM foram reduzidos. O Xpert MTB/RIF contribui significativamente para o diagnóstico de TBM, principalmente quando associado aos testes microbiológicos convencionais e algoritmos clínicos.
Databáze: OpenAIRE
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