University of Kansas, Kansas City, KS, USA.
University of Cape Town, Cape Town, South Africa.
J Med Microbiol. 2019 May;68(5):755-760. doi: 10.1099/jmm.0.000975. Epub 2019 Apr 17.
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 ~10-15 % sensitive. Culture has 50-60 % sensitivity but is slow. Xpert MTB/Rif Ultra is a rapid, automated PCR-based assay with ~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.
结核性脑膜炎（TB 脑膜炎）由于其少菌性疾病性质，极难诊断，需要新的技术。提高检测敏感性将使临床医生对诊断检测更有信心，并有可能改善患者的预后。TB 脑膜炎的传统微生物学和分子检测方法侧重于检测结核杆菌，但其不够充分。涂片显微镜检查快速，但敏感性仅约为 10-15%。培养具有 50-60%的敏感性，但速度较慢。Xpert MTB/Rif Ultra 是一种快速、自动化的基于 PCR 的检测方法，与临床病例定义相比具有约 70%的敏感性。因此，即使是目前最好的检测方法也可能漏诊约 30%的病例。临床医生经常不得不凭经验用具有显著副作用的长期方案进行治疗，或者冒着漏诊的风险，而漏诊可能导致死亡。我们建议，不严格依靠微生物学或分子检测来诊断 TB 脑膜炎，而检测 CSF 中宿主反应的生物标志物可能在改善 TB 脑膜炎的诊断方面发挥辅助作用。
