Winichakoon Poramed, Watcharasaksilp Kanokwan, Butphet Sunisa, Wongworapat Kanlaya, Pantip Chansom, Khamnoi Phadungkiat, Supparatpinyo Khuanchai, Salee Parichat
Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intavaroros Rd., Muaeng, Chiang Mai, 50200, Thailand.
Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Sci Rep. 2025 Jan 29;15(1):3675. doi: 10.1038/s41598-025-87739-5.
Early diagnosis and appropriate treatment are essential for reducing morbidity and mortality in tuberculous meningitis (TBM). This study aimed to evaluate the diagnostic performance of the Xpert MTB/RIF assay for the diagnosis of TBM in patients with subacute lymphocytic meningitis. This cross-sectional study included 65 cerebrospinal fluid (CSF) specimens from patients at Maharaj Nakorn Chiang Mai University Hospital, Thailand, between January 2015 and March 2016. Mycobacteria growth indicator tube (MGIT) culture was used as the reference standard. Sensitivity, specificity, and agreement between Xpert MTB/RIF and MGIT culture were calculated. Sequential testing using a TBM score, followed by Xpert MTB/RIF was also analyzed. Xpert MTB/RIF demonstrated 83.33% sensitivity (95% CI 57.19-98.22) and 96.23% specificity (95% CI 87.02-99.54). Agreement between Xpert MTB/RIF and MGIT culture was 93.85% (p < 0.001), with a kappa score of 0.80 (95% CI 0.60-0.99). Sequential testing with a TBM score cut-off of 6, followed by Xpert MTB/RIF improved specificity from 96.23 to 97.15%. The Xpert MTB/RIF assay is a rapid and valuable tool for detecting Mycobacterium tuberculosis in centrifuged CSF specimens. A diagnostic algorithm incorporating the TBM score enhances performance, balancing sensitivity and specificity, and could improve patient outcomes in resource-limited settings.
早期诊断和适当治疗对于降低结核性脑膜炎（TBM）的发病率和死亡率至关重要。本研究旨在评估Xpert MTB/RIF检测对亚急性淋巴细胞性脑膜炎患者TBM诊断的性能。这项横断面研究纳入了2015年1月至2016年3月期间泰国清迈大学玛哈拉吉那空医院65例患者的脑脊液（CSF）标本。采用分枝杆菌生长指示管（MGIT）培养作为参考标准。计算了Xpert MTB/RIF与MGIT培养之间的敏感性、特异性和一致性。还分析了使用TBM评分进行序贯检测，随后进行Xpert MTB/RIF检测的情况。Xpert MTB/RIF的敏感性为83.33%（95%CI 57.19 - 98.22），特异性为96.23%（95%CI 87.02 - 99.54）。Xpert MTB/RIF与MGIT培养之间的一致性为93.85%（p < 0.001），kappa评分为0.80（95%CI 0.60 - 0.99）。以TBM评分为6进行序贯检测，随后进行Xpert MTB/RIF检测，特异性从96.23%提高到97.15%。Xpert MTB/RIF检测是一种快速且有价值的工具，可用于检测离心脑脊液标本中的结核分枝杆菌。纳入TBM评分的诊断算法可提高性能，平衡敏感性和特异性，并可改善资源有限环境下患者的治疗结果。
