Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.
J Clin Microbiol. 2014 Jan;52(1):226-33. doi: 10.1128/JCM.01834-13. Epub 2013 Nov 6.
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. Rifampin (RIF) resistance results by Xpert were confirmed by an MTBDR-Plus line probe assay and all positive cultures were tested by phenotypic MGIT drug susceptibility testing. Overall, 182/379 included patients (48.0%) were diagnosed with tuberculous meningitis. Sensitivities of Xpert, smear, and MGIT culture among patients diagnosed with TBM were 59.3% (108/182 [95% confidence interval {CI}, 51.8 to 66.5%]), 78.6% (143/182 [95% CI, 71.9 to 84.3%]) and 66.5% (121/182 [95% CI, 59.1 to 73.3%]), respectively. There was one false-positive Xpert MTB/RIF test (99.5% specificity). Four cases of RIF resistance (4/109; 3.7%) were identified by Xpert, of which 3 were confirmed to be multidrug-resistant (MDR) TBM and one was culture negative. Xpert MTB/RIF is a rapid and specific test for the diagnosis of tuberculous meningitis. The addition of a vortexing step to sample processing increased sensitivity for confirmed TBM by 20% (P = 0.04). Meticulous examination of a smear from a large volume of cerebrospinal fluid (CSF) remains the most sensitive technique but is not practical in most laboratories. The Xpert MTB/RIF represents a significant advance in the early diagnosis of this devastating condition.
结核性脑膜炎（TBM）是最严重的结核病形式。微生物学确认很少见，治疗往往延迟，导致死亡率和发病率增加。GeneXpert MTB/RIF 测试在一大群疑似结核性脑膜炎患者中进行了评估。2011 年 4 月 17 日至 2012 年 12 月 31 日期间，越南胡志明市热带病医院收治了 379 例疑似结核性脑膜炎患者，将其纳入本研究。对脑脊液样本进行 Ziehl-Neelsen 染色、分枝杆菌生长指示管（MGIT）培养和 Xpert MTB/RIF 检测。通过 Xpert 检测得到的利福平（RIF）耐药结果通过 MTBDR-Plus 线探针检测得到确认，所有阳性培养物均通过表型 MGIT 药物敏感性检测进行检测。总体而言，纳入的 379 例患者中有 182 例（48.0%）被诊断为结核性脑膜炎。在诊断为 TBM 的患者中，Xpert、涂片和 MGIT 培养的敏感性分别为 59.3%（108/182[95%置信区间{CI}，51.8 至 66.5%]）、78.6%（143/182[95%CI，71.9 至 84.3%]）和 66.5%（121/182[95%CI，59.1 至 73.3%]）。Xpert MTB/RIF 有 1 次假阳性试验（特异性 99.5%）。Xpert 检测到 4 例 RIF 耐药（4/109；3.7%），其中 3 例为耐多药（MDR）TBM，1 例培养阴性。Xpert MTB/RIF 是一种快速且特异性的结核性脑膜炎诊断检测方法。在样本处理中增加涡旋步骤可将确诊 TBM 的敏感性提高 20%（P=0.04）。仔细检查大量脑脊液（CSF）的涂片仍然是最敏感的技术，但在大多数实验室中并不实用。Xpert MTB/RIF 是这种破坏性疾病早期诊断的重大进展。
