Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, USA.
Infectious Diseases Institute, College of Health Sciences, Makerere University, PO Box 22418, Kampala, Uganda.
Tuberculosis (Edinb). 2022 Jul;135:102230. doi: 10.1016/j.tube.2022.102230. Epub 2022 Jun 24.
Cerebrospinal fluid (CSF) Ziehl-Neelsen acid-fast bacilli (AFB) smear is a rapid, cheap, widely available test for tuberculous meningitis (TBM). Yet, reported test sensitivity is highly variable. We performed a systematic review and meta-analysis for CSF AFB smear vs. other mycobacterial tests to diagnose TBM.
We searched MEDLINE and Embase for studies reporting sensitivity and specificity of AFB smear against mycobacterial tests (reference standard) in adults (≥15 years) with suspected TBM. We used the QUADAS-2 tool to assess risk of bias. We estimated pooled sensitivity and specificity of AFB smear versus the reference standard using random-effects bivariate modeling. We used the I statistic to assess heterogeneity between studies.
Of 981 articles identified, 11 were eligible for inclusion with a total of 1713 participants. Seven studies were from high-TB burden settings and 4 from low-TB burden settings. The pooled sensitivity and specificity of CSF AFB smear were 8% (95%CI 3-21) and 100% (95%CI 90-100), with substantial heterogeneity in diagnostic performance (I >95% for both) and reference standards.
CSF AFB smear has poor sensitivity in most settings. If other more sensitive tests are available, those should be used preferentially rather than CSF AFB smear.
脑脊液（CSF）Ziehl-Neelsen 抗酸杆菌（AFB）染色是一种快速、廉价、广泛可用的结核性脑膜炎（TBM）检测方法。然而，报道的检测灵敏度差异很大。我们对 CSF AFB 染色与其他分枝杆菌检测方法进行了系统评价和荟萃分析，以诊断 TBM。
我们在 MEDLINE 和 Embase 中搜索了报告成人（≥15 岁）疑似 TBM 患者 CSF AFB 染色对分枝杆菌检测（参考标准）的灵敏度和特异性的研究。我们使用 QUADAS-2 工具评估偏倚风险。我们使用随机效应二变量模型估计 AFB 染色与参考标准的合并灵敏度和特异性。我们使用 I 统计量评估研究之间的异质性。
从 981 篇文章中筛选出 11 篇符合纳入标准的研究，共纳入 1713 名参与者。7 项研究来自高结核负担地区，4 项来自低结核负担地区。CSF AFB 染色的合并灵敏度和特异性分别为 8%（95%CI 3-21）和 100%（95%CI 90-100），诊断性能（两者的 I >95%）和参考标准存在较大异质性。
在大多数情况下，CSF AFB 染色的灵敏度较低。如果有其他更敏感的检测方法可用，应优先使用这些方法，而不是 CSF AFB 染色。
