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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(11): 700-707
DOI: 10.1590/0004-282X20200067
Article

Diagnostic characteristics of Xpert MTB/RIF assay for the diagnosis of tuberculous meningitis and rifampicin resistance in Southern Brazil

Características diagnósticas do Xpert MTB/RIF para o diagnóstico de meningite tuberculosa e resistência à rifampicina no Sul do Brasil

Authors

  • Sergio Monteiro de Almeida 

    1   Universidade Federal do Paraná, Hospital de Clínicas, Ambulatório de Neuroinfecção Curitiba PR, Brazil.
    2   Universidade Federal do Paraná, Hospital de Clínicas, Laboratório de virologia, Curitiba PR, Brazil.

  • Gislene Maria Botão Kussen 

    3   Universidade Federal do Paraná, Hospital de Clínicas, Laboratório de Bacteriologia, Curitiba PR, Brazil.

  • Laura Cogo 

    3   Universidade Federal do Paraná, Hospital de Clínicas, Laboratório de Bacteriologia, Curitiba PR, Brazil.

  • José Henrique Carvalho 

    1   Universidade Federal do Paraná, Hospital de Clínicas, Ambulatório de Neuroinfecção Curitiba PR, Brazil.

  • Keite Nogueira 

    3   Universidade Federal do Paraná, Hospital de Clínicas, Laboratório de Bacteriologia, Curitiba PR, Brazil.
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ABSTRACT

Background: The timely diagnosis of tuberculous meningitis (TBM) is challenging. Molecular diagnostic tools are necessary for TBM, particularly in low- and middle-income countries. Objectives: We aimed to calculate the diagnostics characteristics of Xpert MTB/RIF for the detection of Mycobacterium tuberculosis in the cerebrospinal fluid (CSF) and the frequency of rifampicin (RIF)-resistance in the CSF samples. Methods: A total of 313 consecutive CSF samples were studied and categorized into TBM definite, probable, possible, or not TBM cases based on the clinical, laboratory, and imaging data. Results: For the definite TBM cases (n=7), the sensitivity, specificity, efficiency, and positive likelihood ratio were 100, 97, 97, and 38%, respectively. However, for the TBM definite associated with the probable cases (n=24), the sensitivity decreased to 46%. All CSF samples that were Xpert MTB/RIF-positive were RIF susceptible. Conclusion: Xpert MTB/RIF showed high discriminating value among the microbiology-proven TBM cases, although the values for the probable and possible TBM cases were reduced. Xpert MTB/RIF contributes significantly to the diagnosis of TBM, mainly when coupled with the conventional microbiological tests and clinical algorithms.

RESUMO

Introdução: O diagnóstico da meningite tuberculosa (TBM) é desafiador. Ferramentas de diagnóstico molecular são necessárias para esse diagnóstico, particularmente em países de baixa e média renda. Objetivos: Calcular as características diagnósticas do Xpert MTB/RIF para a detecção de Mycobacterium tuberculosis no líquido cefalorraquidiano (LCR) e a frequência de resistência à rifampicina (RIF) nas amostras do LCR. Métodos: Um total de 313 amostras consecutivas de LCR foram estudadas e categorizadas em casos de TBM definida, provável, possível ou não TBM, com base nos dados clínicos, laboratoriais e de imagem. Resultados: Para os casos definidos de TBM (n=7), sensibilidade, especificidade, eficiência e razão de verossimilhança positiva foram de 100, 97, 97 e 38%, respectivamente. No entanto, para os casos de TBM definidos associados aos prováveis (n=24), a sensibilidade diminuiu para 46%. Todas as amostras de LCR que foram positivas para Xpert MTB/RIF foram suscetíveis a RIF. Conclusão: O Xpert MTB/RIF mostrou alto valor discriminante entre os casos TBM comprovados por microbiologia, porém o valor nos casos prováveis e possíveis de TBM foram reduzidos. O Xpert MTB/RIF contribui significativamente para o diagnóstico de TBM, principalmente quando associado aos testes microbiológicos convencionais e algoritmos clínicos.

Keywords:

Central Nervous System - Diagnosis - Tuberculosis, Meningeal - Polymerase Chain Reaction

Palavras-chave:

Sistema Nervoso Central - Diagnóstico - Tuberculose Meníngea - Reação em Cadeia da Polimerase

Authors contributions:

All the authors participated in the concept, data collection, analysis and data interpretation, and paper writing.




Publication History

Received: 19 February 2020

Accepted: 21 May 2020

Article published online:
07 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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