GeneXpert MTB/Rif to Diagnose Tuberculous Meningitis: Perhaps the First Test but not the Last
GeneXpert MTB/Rif to Diagnose Tuberculous Meningitis: Perhaps the First Test but not the Last
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DOI：
10.1093/cid/ciw083
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发表时间：
2016-05-01
影响因子：
11.8
通讯作者：
Boulware, David R.
中科院分区：
文献类型：
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作者：
Bahr, Nathan C.;Marais, Suzaan;Boulware, David R.
结核性脑膜炎（TBM）是结核性脑膜炎中最严重的一种，死亡率很高. 2015年5月，来自10个国家的54名研究人员在越南达拉特开会，讨论TBM的进展。与会者中有参与Xpert MTB/Rif用于TBM诊断的关键研究的研究人员。与会者讨论了2014年世界卫生组织的强烈建议，即如果样本量较低或无法获得额外样本进行快速诊断，则优先使用Xpert而不是传统的显微镜和培养作为脑脊液（CSF）的初始诊断检测。“与会者担心没有强调Xpert检测TBM的局限性。TBM的研究途径需要明确的指导，包括关于研究诊断包的建议，这并不止于Xpert检测。其次，需要强调Xpert检测所需的大CSF体积（理想情况下为8-10 mL）。指南还应强调，结核病是一种医疗紧急情况，早期治疗可降低死亡率。
Tuberculous meningitis (TBM) is the most severe form of tuberculous with substantial mortality. In May 2015, 54 researchers from 10 countries met in Da Lat, Vietnam, to discuss advances in TBM. Among the attendees were researchers involved in pivotal studies on the use of Xpert MTB/Rif for TBM diagnosis. Attendees discussed the 2014World Health Organization strong recommendation favoring the use of Xpert "in preference to conventional microscopy and culture as the initial diagnostic test for cerebrospinal fluid (CSF) if the sample volume is low or if additional specimens cannot be obtained to make a quick diagnosis." Attendees were concerned that the limitations of Xpert testing for TBM are not emphasized. Clear guidance is needed for the investigational pathway for TBM, including recommendations on the diagnostic package of investigations, which does not stop with Xpert testing. Second, emphasis on the large CSF volumes (ideally 8-10 mL) needed for Xpert testing is required. Guidelines should also emphasize that TBM is a medical emergency and early treatment reduces mortality.