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@article{Metcalf:2018:10.1371/journal.pone.0198695,
author = {Metcalf, T and Soria, J and Montano, SM and Ticona, E and Evans, CA and Huaroto, L and Kasper, M and Ramos, ES and Mori, N and Jittamala, P and Chotivanich, K and Chavez, IF and Singhasivanon, P and Pukrittayakamee, S and Zunt, JR},
doi = {10.1371/journal.pone.0198695},
journal = {PLoS One},
pages = {1--15},
title = {Evaluation of the GeneXpert MTB/RIF in patients with presumptive tuberculous meningitis},
url = {http://dx.doi.org/10.1371/journal.pone.0198695},
volume = {13},
year = {2018}
}

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TY  - JOUR
AB  - BackgroundMeningitis 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).MethodsPatients 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.Results81% (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 h
AU  - Metcalf,T
AU  - Soria,J
AU  - Montano,SM
AU  - Ticona,E
AU  - Evans,CA
AU  - Huaroto,L
AU  - Kasper,M
AU  - Ramos,ES
AU  - Mori,N
AU  - Jittamala,P
AU  - Chotivanich,K
AU  - Chavez,IF
AU  - Singhasivanon,P
AU  - Pukrittayakamee,S
AU  - Zunt,JR
DO  - 10.1371/journal.pone.0198695
EP  - 15
PY  - 2018///
SN  - 1932-6203
SP  - 1
TI  - Evaluation of the GeneXpert MTB/RIF in patients with presumptive tuberculous meningitis
T2  - PLoS One
UR  - http://dx.doi.org/10.1371/journal.pone.0198695
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000435528600041&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198695
UR  - http://hdl.handle.net/10044/1/84130
VL  - 13
ER  -

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Professor Carlton A W Evans

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