Affiliation:
1. Oxford University Clinical Research Unit, Hospital for Tropical Diseases
2. Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford OX3 7LJ, United Kingdom
3. Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
Abstract
ABSTRACT
The role of nucleic acid amplification techniques in the rapid diagnosis of tuberculous meningitis remains uncertain. We compared the performance of Ziehl-Neelsen (ZN) staining, the Gen-Probe amplified
Mycobacterium tuberculosis
direct test (MTD), and culture with 341 cerebrospinal fluid specimens from 152 adults (73 with and 79 without tuberculous meningitis) before and after inception of antituberculosis chemotherapy. The sensitivity, specificity, and positive and negative predictive values of ZN staining before treatment were 34/66 (52%), 79/79 (100%), 34/34 (100%), and 79/111 (71%), compared with 25/66 (38%), 78/79 (99%), 25/26 (96%), and 79/120 (66%) for MTD. The sensitivity of combined ZN staining and MTD (either positive) was 45/66 (68%). The sensitivity of staining and culture fell more rapidly than that of MTD after the start of treatment: after 5 to 15 days of treatment, MTD was more sensitive than ZN staining (12/43 [28%] versus 2/43 [2%];
P
= 0.013). Slower bacterial clearance was observed if
M. tuberculosis
was resistant to isoniazid and/or streptomycin: resistant organisms were more likely to be cultured from cerebrospinal fluid after 2 to 5 days of treatment than fully sensitive organisms (
P
< 0.001). The sensitivities of ZN staining, MTD, and the two tests combined were improved by repeated sampling to 38/59 (64%), 35/59 (59%), and 49/59 (83%), respectively. In conclusion, ZN staining of the cerebrospinal fluid is at least as good as MTD for the rapid diagnosis of tuberculosis and is much faster and less expensive. However, the combination of these methods on serial samples detects more cases. Alternative tests are still urgently required.
Publisher
American Society for Microbiology
Reference23 articles.
1. Baker, C. A., C. P. Cartwright, D. N. Williams, S. M. Nelson, and P. K. Peterson. 2002. Early detection of central nervous system tuberculosis with the Gen-Probe nucleic acid amplification assay: utility in an inner city hospital. Clin. Infect. Dis.35:339-342.
2. Bonington, A., J. I. Strang, P. E. Klapper, S. V. Hood, A. Parish, P. J. Swift, J. Damba, H. Stevens, L. Sawyer, G. Potgieter, A. Bailey, and E. G. Wilkins. 2000. TB PCR in the early diagnosis of tuberculous meningitis: evaluation of the Roche semi-automated COBAS Amplicor MTB test with reference to the manual Amplicor MTB PCR test. Tuber. Lung Dis.80:191-196.
3. Use of Roche AMPLICOR
Mycobacterium tuberculosis
PCR in Early Diagnosis of Tuberculous Meningitis
4. Brienze, V. M., A. P. Tonon, F. J. Pereira, E. Liso, W. A. Tognola, M. A. dos Santos, and M. U. Ferreira. 2001. Low sensitivity of polymerase chain reaction for diagnosis of tuberculous meningitis in southeastern Brazil. Rev. Soc. Bras. Med. Trop.34:389-393.
5. Chedore, P., and F. B. Jamieson. 2002. Rapid molecular diagnosis of tuberculous meningitis using the Gen-Probe amplified Mycobacterium tuberculosis direct test in a large Canadian public health laboratory. Int. J. Tuberc. Lung Dis.6:913-919.
Cited by
81 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献