The diagnostic performance of GeneXpert MTB/RIF in tuberculosis meningitis: A multicentre accuracy study

Chenyuan Wang; Lina Davies Forsman; Shanshan Wang; Sainan Wang; Ge Shao; Haiyan Xiong; Ziwei Bao; Yi Hu

doi:10.1016/j.diagmicrobio.2024.116277

The diagnostic performance of GeneXpert MTB/RIF in tuberculosis meningitis: A multicentre accuracy study

Diagn Microbiol Infect Dis. 2024 Apr 10;109(3):116277. doi: 10.1016/j.diagmicrobio.2024.116277. Online ahead of print.

Authors

Chenyuan Wang¹, Lina Davies Forsman², Shanshan Wang¹, Sainan Wang¹, Ge Shao¹, Haiyan Xiong¹, Ziwei Bao³, Yi Hu¹

Affiliations

¹ Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China and Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, China.
² Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
³ Suzhou Fifth People's Hospital, Suzhou City, Jiangsu, China. Electronic address: baoziwei521@126.com.

PMID: 38677052
DOI: 10.1016/j.diagmicrobio.2024.116277

Abstract

Objectives: To evaluate the performance of GeneXpert MTB/RIF (Xpert) for tuberculous meningitis (TBM) and to identify additional indicators to improve diagnostic accuracy.

Methods: An accuracy study was conducted. During 2011-2019, 243 TBM with 140 non-TBM in three TB-designated facilities in China were enrolled. Microbiological evidence of M tuberculosis (Mtb) in CSF was used as the reference. Additional indicators were identified by Boosted-Classification and Regression Tree (CART), the improvement of diagnostic performance was evaluated by ROC.

Results: The diagnostic sensitivity of Xpert was 71.1 % for definite TBM, and 5.5 % for probable/possible TBM. The positive rate of Xpert was improved with cerebrospinal fluid (CSF) increasing volume and was associated with CSF color (yellow). The additional indicators obtained by CART were CSF lactate and glucose and increased the sensitivity to 96.1 % (definite TBM) and 84.6 % (probable/possible TBM).

Conclusions: The diagnostic performance of Xpert was satisfactory in definite TBM and would significantly be improved by the additional use of CSF lactate and glucose.

Keywords: GeneXpert MTB/RIF; Tuberculous meningitis; accuracy; diagnostic tools; lactate.