Ssebambulidde Kenneth, Gakuru Jane, Ellis Jayne, Cresswell Fiona V, Bahr Nathan C
Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Front Neurol. 2022 May 30;13:892224. doi: 10.3389/fneur.2022.892224. eCollection 2022.
Diagnosis of tuberculous meningitis (TBM) remains challenging due to a paucity of high-performance diagnostics. Even those that have reasonable sensitivity are not adequate to 'rule out' TBM. Therefore, a combination of clinical factors alongside microbiological, molecular, and radiological investigations are utilized, depending on availability. A low threshold for starting empiric therapy in the appropriate clinical scenario remains crucial for good outcomes in many cases. Herein, we review the current TBM diagnostics landscape with a focus on limitations frequently encountered, such as diagnostic test performance, cost, laboratory infrastructure, and clinical expertise. Though molecular technologies, particularly GeneXpert MTB/Rif Ultra, have been a step forward, diagnosis of TBM remains difficult. We also provide an overview of promising technologies, such as cerebrospinal fluid (CSF) lactate, a new lipoarabinomannan test (FujiLAM), metagenomic next-generation sequencing, and transcriptomics that may further improve our TBM diagnostic capacity and lead to better outcomes.
由于缺乏高性能的诊断方法，结核性脑膜炎（TBM）的诊断仍然具有挑战性。即使是那些具有合理敏感性的方法，也不足以“排除”TBM。因此，根据可获得性，综合利用临床因素以及微生物学、分子学和放射学检查。在许多情况下，在适当的临床场景中启动经验性治疗的低阈值对于取得良好预后仍然至关重要。在此，我们回顾当前TBM诊断的情况，重点关注经常遇到的局限性，如诊断测试性能、成本、实验室基础设施和临床专业知识。尽管分子技术，特别是GeneXpert MTB/Rif Ultra，已经取得了进展，但TBM的诊断仍然困难。我们还概述了一些有前景的技术，如脑脊液（CSF）乳酸、一种新的脂阿拉伯甘露聚糖检测（FujiLAM）、宏基因组下一代测序和转录组学，这些技术可能会进一步提高我们对TBM的诊断能力并带来更好的结果。
