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J Clin Microbiol. 2015 Aug;53(8):2667-73. doi: 10.1128/JCM.00624-15. Epub 2015 Jun 10.

Accuracy of Lipoarabinomannan and Xpert MTB/RIF Testing in Cerebrospinal Fluid To Diagnose Tuberculous Meningitis in an Autopsy Cohort of HIV-Infected Adults.

Author information

1
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda jannekecox@xs4all.nl.
2
Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda.
3
Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda Department of Pathology, Mulago Hospital, Kampala, Uganda.
4
Department of Pathology, University Hospital Antwerp, University of Antwerp, Antwerp, Belgium.
5
Department of Diagnostic Oncology & Molecular Pathology, Netherlands Cancer Institute-Antonie van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
6
Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
7
Joint Pathology Center, Silver Spring, Maryland, USA.
8
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium.
9
Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Abstract

Point-of-care tests for tuberculous meningitis (TBM) are needed. We studied the diagnostic accuracy of the lipoarabinomannan (LAM) lateral flow assay (LFA), LAM enzyme-linked immunosorbent assay (ELISA), and Xpert MTB/RIF in cerebrospinal fluid (CSF) in an autopsy cohort of Ugandan HIV-infected adults. We obtained written informed consent postmortem from the next of kin. A complete autopsy was done and CSF obtained. We performed LAM LFA (on unprepared and supernatant CSF after heating and spinning), LAM ELISA, and Xpert MTB/RIF on the CSF samples. Accuracy parameters were calculated for histopathological TBM and also for the composite standard, including Xpert MTB/RIF-positive cases. We tested CSF of 91 patients. LAM LFA had a sensitivity of 75% for definite histopathological TBM, ELISA a sensitivity of 43%, and Xpert MTB/RIF a sensitivity of 100% and specificities of 87%, 91%, and 87%, respectively. LAM LFA had a sensitivity of 50% for definite and probable histopathological TBM, ELISA a sensitivity of 38%, and Xpert MTB/RIF a sensitivity of 86% and specificities of 70%, 91%, and 87%, respectively. LAM LFA had a sensitivity of 68% for the composite standard and ELISA a sensitivity of 48% and specificities of 78% and 98%, respectively. The rapid diagnostic tests detected TBM in 22% to 78% of patients not on anti-TB treatment. Point-of-care tests have high accuracy in diagnosis of TBM in deceased HIV-infected adults. LAM LFA in CSF is a useful additional diagnostic tool.

PMID:
26063865
PMCID:
PMC4508395
DOI:
10.1128/JCM.00624-15
[Indexed for MEDLINE]
Free PMC Article

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