Journal
JOURNAL OF MEDICAL MICROBIOLOGY
Volume 68, Issue 5, Pages 755-760Publisher
MICROBIOLOGY SOC
DOI: 10.1099/jmm.0.000975
Keywords
tuberculosis meningitis; Mycobacterium tuberculosis; opportunistic infection; delayed diagnosis; diagnostic techniques and procedures
Categories
Funding
- National Institute of Neurologic Diseases and Stroke [R01NS086312]
- Wellcome Trust [098316]
- South African Research Chairs Initiative of the Department of Science and Technology
- National Research Foundation (NRF) of South Africa [64787]
- NRF incentive funding [85858]
- South African Medical Research Council through its TB and HIV Collaborating Centres Programme
- National Department of Health (RFA) [SAMRC-RFA-CC: TB/HIV/AIDS-01-2014]
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Tuberculosis (TB) meningitis is extremely difficult to diagnose due to its pauci-bacillary disease nature and new techniques are needed. Improved test sensitivity would allow for greater clinician confidence in diagnostic testing and has the potential to improve patient outcomes. Traditional microbiologic and molecular tests for TB meningitis focus on detection of TB bacilli and are inadequate. Smear microscopy is rapid but only similar to 10-15 % sensitive. Culture has 50-60 % sensitivity but is slow. Xpert MTB/Rif Ultra is a rapid, automated PCR-based assay with similar to 70 % sensitivity versus clinical case definition. Thus, even the best current testing may miss up to 30 % of cases. Clinicians are often left to treat empirically with prolonged regimens with significant side effects or risk a missed case that would result in death. Rather than relying strictly on microbiologic or molecular testing to diagnose TB meningitis, we propose that testing of CSF for biomarkers of host response may have an adjunctive role to play in improving the diagnosis of TB meningitis.
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