Neuroinfection Outclinic, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
Bacteriology Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
Curr HIV Res. 2020;18(4):267-276. doi: 10.2174/1570162X18666200505083728.
Tuberculous meningitis (TbM) is the most severe complication of extra pulmonary tuberculosis (Tb). There is a higher frequency of positive cerebrospinal fluid (CSF) cultures for Mycobacterium tuberculosis (MTb) in samples from human immunodeficiency virus (HIV) co-infected patients than in those from HIV-negative patients. We hypothesized that real time PCR assays for MTb (MTb qPCR) using CSF would be more sensitive in HIV co-infected patients owing to a greater MTb burden. The present study aimed to verify the diagnostic performance of MTb qPCR in CSF of TbM patients who either were co-infected with HIV or were HIVnegative.
A total of 334 consecutive participants with suspected TbM were divided into two groups: HIV co-infected and HIV-negative; each group was categorized into definite TbM, probable TbM, possible TbM, and TbM-negative subgroups based on clinical, laboratory and imaging data. We evaluated the diagnostic characteristics of MTb qPCR analysis to detect TbM in CSF by comparing the results to those obtained for definite TbM (i.e., positive MTb culture) and/or probable TbM in CSF, as gold standard.
The sensitivity of MTb qPCR in the definite and probable subgroups of the HIV coinfected participants (n = 14) was 35.7%, with a specificity of 93.8%, negative predictive value (NPV) of 94.4%, and negative clinical utility index (CUI-) of 0.89. Results of the HIV-negative group (n = 7) showed lower sensitivity (14.3%) and similar specificity, NPV, and CUI-.
The findings confirmed our hypothesis, despite the low sensitivity. MTb qPCR may significantly contribute to diagnosis when associated with clinical criteria and complementary examinations.
结核性脑膜炎（TBM）是肺外结核（TB）最严重的并发症。人类免疫缺陷病毒（HIV）合并感染患者的脑脊液（CSF）分枝杆菌结核（MTb）培养阳性率高于 HIV 阴性患者。我们假设，由于 MTb 负担增加，使用 CSF 的 MTb 实时 PCR 检测（MTb qPCR）在 HIV 合并感染患者中更敏感。本研究旨在验证 MTb qPCR 在 TBM 患者的 CSF 中的诊断性能，这些患者要么合并感染 HIV，要么为 HIV 阴性。
334 例疑似 TBM 的连续患者分为两组：HIV 合并感染和 HIV 阴性；根据临床、实验室和影像学数据，每组分为明确 TBM、可能 TBM、可能 TBM 和 TBM 阴性亚组。我们通过将 MTb qPCR 分析结果与 CSF 中明确 TBM（即 MTb 培养阳性）和/或可能 TBM 作为金标准进行比较，评估 MTb qPCR 分析检测 CSF 中 TBM 的诊断特征。
HIV 合并感染患者的明确和可能亚组中 MTb qPCR 的敏感性为 35.7%，特异性为 93.8%，阴性预测值（NPV）为 94.4%，阴性临床效用指数（CUI-）为 0.89。HIV 阴性组（n=7）的结果显示敏感性较低（14.3%），特异性、NPV 和 CUI-相似。
尽管敏感性较低，但研究结果证实了我们的假设。MTb qPCR 与临床标准和补充检查相结合，可能对诊断有重要贡献。
