title: GeneXpert MTB/RIF assay as initial test for diagnosis of tuberculous meningitis.
abstract: Tuberculous meningitis (TBM) remains the most dangerous form of tuberculosis with high mortality and potential complications. The prompt diagnosis and treatment of this condition remains a key for better prognosis. A 39-year-old woman presented with severe headache, fever, nausea and vomiting, with a history of headache for a month. On examination, confusion, neck rigidity, ptosis and upward plantar reflexes were present. After 7 days of empiric treatment without resolution of her symptoms, she had another spinal tap performed. The diagnosis of TBM was performed by the GeneXpert MTB/RIF assay from her cerebrospinal fluid (CSF). Antitubercular chemotherapy was started. The patient subsequently improved. Where available, the GeneXpert assay should be used immediately in CSF samples of patients suspected of TBM as an adjunct to clinical algorithms to increase the chance of a prompt diagnosis and treatment.
authors.affiliation: Clinical Research Unit, Oxford University, Patan Hospital, Kathmandu, Nepal.
authors.forename: Poojan
authors.initials: P
authors.lastname: Shrestha
authors.affiliation: Department of Internal Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal.
authors.forename: Buddhi
authors.initials: B
authors.lastname: Paudyal
authors.affiliation: Clinical Research Unit, Oxford University, Kathmandu, Nepal.
authors.forename: Buddha
authors.initials: B
authors.lastname: Basnyat
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage*; D005260:Female; D005334:Fever / Q000382:microbiology; D020773:Headache Disorders / Q000382:microbiology; D006801:Humans; D008826:Microbial Sensitivity Tests; D025202:Molecular Diagnostic Techniques; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011379:Prognosis; D013129:Spinal Puncture / Q000379:methods*; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid* / Q000175:diagnosis*
chemical_list: D000995:Antitubercular Agents