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xpert meningitis

Ting Wang, Guo-Dong Feng, Yu Pang, Jia-Yun Liu, Yang Zhou, Yi-Ning Yang, Wen Dai, Lin Zhang, Qiao Li, Yu Gao, Ping Chen, Li-Ping Zhan, Ben J Marais, Yan-Lin Zhao, Gang Zhao
The clinical and mycobacterial features of tuberculous meningitis (TBM) cases in China are not well described; especially in western provinces with poor tuberculosis control. We prospectively enrolled patients in whom TBM was considered in Shaanxi Province, northwestern China, over a 2-year period (September 2010 to December 2012). Cerebrospinal fluid specimens were cultured for Mycobacterium tuberculosis; with phenotypic and genotypic drug susceptibility testing (DST), as well as genotyping of all positive cultures...
2016: Scientific Reports
Nathan C Bahr, Suzaan Marais, Maxine Caws, Reinout van Crevel, Robert J Wilkinson, Jaya S Tyagi, Guy E Thwaites, David R Boulware
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 2014 World 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...
May 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Diego O Andrey, Hanspeter Hinrikson, Gesuele Renzi, Jonathan Hibbs, Dan Adler, Jacques Schrenzel
No abstract text is available yet for this article.
December 2015: International Journal of Tuberculosis and Lung Disease
N C Bahr, L Tugume, R Rajasingham, R Kiggundu, D A Williams, B Morawski, D Alland, D B Meya, J Rhein, D R Boulware
BACKGROUND: TB meningitis (TBM) diagnosis is difficult and novel diagnostic methods are needed. The World Health Organization recommends Xpert(®) MTB/RIF as the initial TBM diagnostic test based on two studies reporting suboptimal sensitivity (~50-60%). OBJECTIVE: To study the effect of cerebrospinal fluid (CSF) centrifugation on Xpert performance for TBM detection. DESIGN: A total of 107 predominantly human immunodeficiency virus (HIV) infected adults with presumed meningitis were screened prospectively in Kampala, Uganda...
October 2015: International Journal of Tuberculosis and Lung Disease
Anna Gamell, Alex John Ntamatungiro, Manuel Battegay, Emilio Letang
A 9-year-old HIV-infected child previously treated with inadequate doses of antitubercular drugs based on weight was admitted 5 months after initial tuberculosis (TB) diagnosis with acute hemiplegia and inguinal lymphadenopathies in a rural hospital in Tanzania. He was diagnosed with TB meningitis and lymphadenitis using Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay. Rifampicin resistance was detected in the lymph node aspirate but not in the cerebrospinal fluid. His TB therapy was optimised based on available medications and antiretroviral treatment was initiated 6 weeks later...
2015: BMJ Case Reports
Janneke A Cox, Robert L Lukande, Sam Kalungi, Eric Van Marck, Martin Lammens, Koen Van de Vijver, Andrew Kambugu, Ann M Nelson, Robert Colebunders, Yukari C Manabe
Point-of-care tests for tuberculous meningitis (TBM) are needed. We studied the diagnostic accuracy of the lipoarabinomannan (LAM) lateral flow assay (LFA), LAM enzyme-linked immunosorbent assay (ELISA), and Xpert MTB/RIF in cerebrospinal fluid (CSF) in an autopsy cohort of Ugandan HIV-infected adults. We obtained written informed consent postmortem from the next of kin. A complete autopsy was done and CSF obtained. We performed LAM LFA (on unprepared and supernatant CSF after heating and spinning), LAM ELISA, and Xpert MTB/RIF on the CSF samples...
August 2015: Journal of Clinical Microbiology
T H Boyles, G E Thwaites
We disagree with the recommendation by the World Health Organization to use Xpert(®) MTB/RIF on cerebrospinal fluid for the initial diagnosis of tuberculous meningitis (TBM). TBM is a devastating disease requiring empirical treatment even when the probability of disease is low. We suggest that a useful TBM diagnostic test needs a negative predictive value (NPV) of ⩾ 99% so that empirical treatment can be stopped safely. The NPV of Xpert is around 84%, making a negative test of limited value. While better tests are awaited, a composite score, possibly combining Xpert with clinical variables and with high NPV, should be constructed and validated prospectively...
March 2015: International Journal of Tuberculosis and Lung Disease
R S Solomons, D H Visser, S O Friedrich, A H Diacon, K G P Hoek, B J Marais, J F Schoeman, A M van Furth
BACKGROUND: Early treatment is critical to reducing tuberculous meningitis (TBM) related morbidity and mortality. Diagnosis based on cerebrospinal fluid (CSF) culture is impractical due to slow turnaround times, while microscopy has poor sensitivity. Enhanced detection methods are essential to guide early treatment initiation, especially in vulnerable young children. METHODS: We assessed the diagnostic accuracy of the GenoType(®) MTBDRplus and Xpert(®) MTB/RIF assays on CSF collected from paediatric meningitis suspects prospectively enrolled at Tygerberg Hospital, Cape Town, South Africa...
January 2015: International Journal of Tuberculosis and Lung Disease
Blake W Buchan, Matthew L Faron, DeAnna Fuller, Thomas E Davis, Donna Mayne, Nathan A Ledeboer
Neonatal infection with Streptococcus agalactiae (group B Streptococcus [GBS]) is a leading cause of sepsis and meningitis in newborns. Recent guidelines have recommended universal screening of all pregnant women to identify those colonized with GBS and administration of peripartum prophylaxis to those identified as carriers to reduce the risk of early-onset GBS disease in neonates. Enriched culture methods are the current standard for prenatal GBS screening; however, the implementation of more sensitive molecular diagnostic tests may be able to further reduce the risk of early-onset GBS infection...
February 2015: Journal of Clinical Microbiology
Radha Rajasingham, Joshua Rhein, Kate Klammer, Abdu Musubire, Henry Nabeta, Andrew Akampurira, Eric C Mossel, Darlisha A Williams, Dave J Boxrud, Mary B Crabtree, Barry R Miller, Melissa A Rolfes, Supatida Tengsupakul, Alfred O Andama, David B Meya, David R Boulware
There is limited understanding of the epidemiology of meningitis among human immunodeficiency virus (HIV)-infected populations in sub-Saharan Africa. We conducted a prospective cohort study of HIV-infected adults with suspected meningitis in Uganda, to comprehensively evaluate the etiologies of meningitis. Intensive cerebrospiral fluid (CSF) testing was performed to evaluate for bacterial, viral, fungal, and mycobacterial etiologies, including neurosyphilis,16s ribosomal DNA (rDNA) polymerase chain reaction (PCR) for bacteria, Plex-ID broad viral assay, quantitative-PCR for HSV-1/2, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Toxoplasma gondii; reverse transcription-PCR (RT-PCR) for Enteroviruses and arboviruses, and Xpert MTB/RIF assay...
February 2015: American Journal of Tropical Medicine and Hygiene
Vincenzo Savini, Roberta Marrollo, Eleonora Coclite, Paola Fusilli, Carmine D'Incecco, Paolo Fazii
We report the case of a late-onset neonatal meningitis by Streptococcus agalactiae (group B Streptococcus - GBS) that was diagnosed with a latex agglutination assay (on cerebrospinal fluid, CSF), as well as by using, for the first time, Xpert GBS (Cepheid, US) on CSF. Due to empirical antibiotics given before sampling, both CSF and blood culture were negative, so the abovementioned diagnostics was crucial. Moreover, the Xpert GBS assay, performed according to an off-label, modified protocol (the system is designed for GBS-carriage intrapartum screening, based on a completely automated real time-Polymerase Chain Reaction) quickly detected the organism's genome target...
2014: International Journal of Clinical and Experimental Pathology
Vinod B Patel, Cathy Connolly, Ravesh Singh, Laura Lenders, Brian Matinyenya, Grant Theron, Thumbi Ndung'u, Keertan Dheda
There are no data about the comparative accuracy of commercially available nucleic acid amplification tests (GeneXpert MTB/RIF and Roche Amplicor) for the diagnosis of tuberculous meningitis (TBM). A total of 148 patients with suspected TBM were evaluated, and cultures served as the reference standard. The sensitivities and specificities (95% confidence interval [CI]) for the Amplicor and Xpert MTB/RIF tests were similar: 46 (31-60) versus 50 (33-67) and 99 (93-100) and 94 (84-99), respectively.
October 2014: Journal of Clinical Microbiology
Claudia M Denkinger, Samuel G Schumacher, Catharina C Boehme, Nandini Dendukuri, Madhukar Pai, Karen R Steingart
Xpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) is endorsed for the detection of pulmonary tuberculosis (TB). We performed a systematic review and meta-analysis to assess the accuracy of Xpert for the detection of extrapulmonary TB. We searched multiple databases to October 15, 2013. We determined the accuracy of Xpert compared with culture and a composite reference standard (CRS). We grouped data by sample type and performed meta-analyses using a bivariate random-effects model. We assessed sources of heterogeneity using meta-regression for predefined covariates...
August 2014: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Regan S Solomons, Sabine L van Elsland, Douwe H Visser, Kim G P Hoek, Ben J Marais, Johan F Schoeman, Anne M van Furth
Although nucleic acid amplification tests (NAATs) promise a rapid, definitive diagnosis of tuberculous meningitis, the performance of first-generation NAATs was suboptimal and variable. We conducted a meta-analysis of studies published between 2003 and 2013, using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool to evaluate methodological quality. The diagnostic accuracy of newer commercial NAATs was assessed. Pooled estimates of diagnostic accuracy for commercial NAATs measured against a cerebrospinal fluid Mycobacterium tuberculosis culture-positive gold standard were sensitivity 0...
April 2014: Diagnostic Microbiology and Infectious Disease
Nguyen Thi Quynh Nhu, Dorothee Heemskerk, Do Dang Anh Thu, Tran Thi Hong Chau, Nguyen Thi Hoang Mai, Ho Dang Trung Nghia, Pham Phu Loc, Dang Thi Minh Ha, Laura Merson, Tran Thi Van Thinh, Jeremy Day, Nguyen van Vinh Chau, Marcel Wolbers, Jeremy Farrar, Maxine Caws
Tuberculous meningitis (TBM) is the most severe form of tuberculosis. Microbiological confirmation is rare, and treatment is often delayed, increasing mortality and morbidity. The GeneXpert MTB/RIF test was evaluated in a large cohort of patients with suspected tuberculous meningitis. Three hundred seventy-nine patients presenting with suspected tuberculous meningitis to the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, between 17 April 2011 and 31 December 2012 were included in the study. Cerebrospinal fluid samples were tested by Ziehl-Neelsen smear, mycobacterial growth indicator tube (MGIT) culture, and Xpert MTB/RIF...
January 2014: Journal of Clinical Microbiology
David R Boulware
David Boulware discusses the challenges of diagnosing tuberculous meningitis and the implications of the study by Patel and colleagues using the Xpert MTB/RIF assay for diagnosis. Please see later in the article for the Editors' Summary.
October 2013: PLoS Medicine
Vinod B Patel, Grant Theron, Laura Lenders, Brian Matinyena, Cathy Connolly, Ravesh Singh, Yacoob Coovadia, Thumbi Ndung'u, Keertan Dheda
BACKGROUND: Tuberculous meningitis (TBM) is difficult to diagnose promptly. The utility of the Xpert MTB/RIF test for the diagnosis of TBM remains unclear, and the effect of host- and sample-related factors on test performance is unknown. This study sought to evaluate the sensitivity and specificity of Xpert MTB/RIF for the diagnosis of TBM. METHODS AND FINDINGS: 235 South-African patients with a meningeal-like illness were categorised as having definite (culture or Amplicor PCR positive), probable (anti-TBM treatment initiated but microbiological confirmation lacking), or non-TBM...
October 2013: PLoS Medicine
Ravindra K Garg, Amita Jain, Hardeep S Malhotra, Avinash Agrawal, Rajiv Garg
Drug-resistant tuberculosis, including drug-resistant tuberculous meningitis, is an emerging health problem in many countries. An association with Beijing strains and drug resistance-related mutations, such as mutations in katG and rpoB genes, has been found. The pathology, clinical features and neuroimaging characteristics of drug-resistant tuberculous meningitis are similar to drug-responsive tuberculous meningitis. Detection of mycobacteria in cerebrospinal fluid (CSF) by conventional methods (smear examination or culture) is often difficult...
June 2013: Expert Review of Anti-infective Therapy
Silva Slika, Fatmeh Abbas, Rami Mahfouz
AIMS: Rapid molecular detection of enterovirus in cerebrospinal fluid (CSF) has revolutionized the diagnosis and treatment modalities of patients with meningitis and largely affected cost of unnecessary antibiotic use and length of stay in hospitals. MATERIALS AND METHODS: Between January 2010 and July 2012, we tested 220 CSF samples on the GeneXpert DX real-time polymerase chain reaction system (by Cepheid) using the Xpert EV kit assays. In addition, we reported 14 sample results cross-validated with an external referral laboratory as well as the results of external proficiency testing...
March 2013: Genetic Testing and Molecular Biomarkers
Ana Isabel Menasalvas-Ruiz, Carme Salvador-García, Antonio Moreno-Docón, Santiago Alfayate-Miguélez, Carlos Pérez Cánovas, Manuel Sánchez-Solís
BACKGROUND: Enteroviruses (EV) are the main aetiological agents of aseptic meningitis in children and a common cause of febrile illnesses in young infants in summer. A rapid diagnosis is essential to rule out other conditions. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay performed in cerebrospinal fluid (CSF) has proved to be a very fast and useful tool. METHODS: We collected demographic, clinical and laboratory data of children (aged 11-years or younger) with EV RT-PCR (Cepheid(®) Xpert EV) positive in CSF from December 2007 to July 2010, to describe EV meningitis in children and to determine the role of this assay...
February 2013: Enfermedades Infecciosas y Microbiología Clínica
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