Improved diagnostic sensitivity for tuberculous meningitis with Xpert(®) MTB/RIF of centrifuged CSF.
Improved diagnostic sensitivity for tuberculous meningitis with Xpert(®) MTB/RIF of centrifuged CSF.
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DOI：
10.5588/ijtld.15.0253
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发表时间：
2015-10
期刊：
影响因子：
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通讯作者：
Boulware DR
中科院分区：
文献类型：
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作者：
Bahr NC;Tugume L;Rajasingham R;Kiggundu R;Williams DA;Morawski B;Alland D;Meya DB;Rhein J;Boulware DR
结核病脑膜炎(TBM)的诊断很困难，需要新的诊断方法。世界卫生组织建议将Xpert MTB/RIF(Xpert)作为TBM的初始诊断测试，这是基于两项报告的敏感性不佳(~50-60%)的研究。目的：研究脑脊液(CSF)离心对脑脊液(TBM)检测的影响。在乌干达坎帕拉对107名疑似脑膜炎的以艾滋病毒感染为主的成年人进行了前瞻性筛查。对脑脊液进行1)抗酸杆菌镜检，2)分支杆菌生长指示管培养，3)未经处理的脑脊液2毫升，4)离心脑脊液。根据任何阳性的脑脊液结核试验的先验综合参考标准来衡量诊断性能。17%(18/107)的受试者有明确的TBM。分离脑脊液时，Xpert的敏感性(72%，13/18)高于未加工脑脊液2ml时的敏感性(28%，5/18；P=0.008)。中位离心量为6ml(IQR4~10ml)。分枝杆菌培养的敏感度为71%(12/17)，平均延迟27天。只有39%的人同时通过培养和离心Xpert检测到阳性，Xpert和培养检测到更多的病例。脑脊液的离心法优化了XPERT检测TBM的诊断性能。培养和Xpert相结合检测到的病例数量最多。
TB meningitis (TBM) diagnosis is difficult and novel diagnostic methods are needed. The World Health Organization recommends Xpert MTB/RIF (Xpert) as the initial TBM diagnostic test, based on two studies reporting suboptimal sensitivity (~50–60%). To study the effect of cerebrospinal fluid (CSF) centrifugation on Xpert performance for TBM detection. 107 predominantly HIV-infected adults with suspected meningitis were screened prospectively in Kampala, Uganda. CSF was tested by 1) microscopy for acid-fast bacilli; 2) Mycobacteria growth indicator tube culture; 3) Xpert of 2mL of unprocessed CSF; 4) Xpert of centrifuged CSF. Diagnostic performance was measured against an a priori composite reference standard of any positive CSF tuberculosis test. 17% (18/107) of participants had definite TBM. When CSF was centrifuged, Xpert had better sensitivity (72%, 13/18) than when using 2mL of unprocessed CSF (28%, 5/18; P=0.008). The median centrifuged CSF volume was 6mL (IQR 4–10mL). Mycobacterial culture yielded 71% (12/17) sensitivity at a median delay of 27 days. Only 39% were positive both by culture and centrifuged Xpert, with additional cases detected by Xpert and culture. Centrifuging of CSF optimizes Xpert diagnostic performance for detection of TBM. A combination of culture and Xpert detected the largest number of cases.