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xpert meningitis

Tom Boyles, Isabella Locatelli, Nicolas Senn, Mark Ebell
Clinical decision thresholds may aid the evaluation of diagnostic tests but have rarely been determined for tuberculosis (TB). We presented clinicians with six web-based clinical scenarios, describing patients with HIV and possible TB at various sites and with a range of clinical stability. The probability of disease was varied randomly and clinicians asked to make treatment decisions; threshold curves and therapeutic thresholds were calculated. Test and treatment thresholds were calculated using Bayes theorem and the diagnostic accuracy of Xpert MTB/RIF...
August 2017: Evidence-based Medicine
Syed Beenish Rufai, Amit Singh, Jitendra Singh, Parveen Kumar, Manimuthu Mani Sankar, Sarman Singh
OBJECTIVE: Tuberculous meningitis (TBM) is the most severe form of extra-pulmonary tuberculosis (TB) due to association of diseases with high rates of mortality and morbidity. Diagnosis continues to be a clinical challenge as microbiological confirmation is rare and time consuming resulting in delayed treatment. Xpert MTB/RIF assay is a rapid and simple test, which has been endorsed by World Health Organization as an initial diagnostic test for the diagnosis of TBM. However, evidence still lacks for its performance on cerebrospinal fluid (CSF) for the diagnosis of TBM especially from India...
August 2017: Journal of Infection
Surendra K Sharma, Alladi Mohan
Miliary tuberculosis (TB) results from a massive lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli and is characterized by tiny tubercles evident on gross pathology resembling millet seeds in size and appearance. The global HIV/AIDS pandemic and widespread use of immunosuppressive drugs and biologicals have altered the epidemiology of miliary TB. Considered to be predominantly a disease of infants and children in the pre-antibiotic era, miliary TB is increasingly being encountered in adults as well...
March 2017: Microbiology Spectrum
Natalia Alonso Pérez, Belén Sagastizabal Cardelus, Luis Manuel Prieto Tato, Sara Guillén Martín, Ana González Torralba, Isabel García Bermejo, José Tomás Ramos Amador
INTRODUCTION: Polymerase chain reaction (PCR) assays have shown to be useful and quick for the diagnosis of enterovirus in aseptic meningitis. The aim of our study was to analyse the changes in clinical practice after the introduction of a real-time polymerase chain reaction (RT-PCR) technique using the Xpert EV (Cepheid(®)) assay for the qualitative detection of enterovirus RNA in cerebrospinal fluid specimens from children with suspected viral meningitis. METHODS: A retrospective study was performed in children older than 1year, diagnosed with enterovirus meningitis in a third level hospital from November 2006 to February 2013...
December 2, 2016: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
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...
May 4, 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
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