title: GeneXpert MTB/Rif to Diagnose Tuberculous Meningitis: Perhaps the First Test but not the Last.
abstract: Tuberculous meningitis (TBM) is the most severe form of tuberculous with substantial mortality. In May 2015, 54 researchers from 10 countries met in Da Lat, Vietnam, to discuss advances in TBM. Among the attendees were researchers involved in pivotal studies on the use of Xpert MTB/Rif for TBM diagnosis. Attendees discussed the 2014 World Health Organization strong recommendation favoring the use of Xpert "in preference to conventional microscopy and culture as the initial diagnostic test for cerebrospinal fluid (CSF) if the sample volume is low or if additional specimens cannot be obtained to make a quick diagnosis." Attendees were concerned that the limitations of Xpert testing for TBM are not emphasized. Clear guidance is needed for the investigational pathway for TBM, including recommendations on the diagnostic package of investigations, which does not stop with Xpert testing. Second, emphasis on the large CSF volumes (ideally 8-10 mL) needed for Xpert testing is required. Guidelines should also emphasize that TBM is a medical emergency and early treatment reduces mortality.
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis.
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Bahr
authors.affiliation: Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, South Africa.
authors.forename: Suzaan
authors.initials: S
authors.lastname: Marais
authors.affiliation: Liverpool School of Tropical Medicine, United Kingdom.
authors.forename: Maxine
authors.initials: M
authors.lastname: Caws
authors.affiliation: Radboud University Nijmegen Medical Center, The Netherlands.
authors.forename: Reinout
authors.initials: R
authors.lastname: van Crevel
authors.affiliation: Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, South Africa Department of Medicine, Imperial College London Francis Crick Institute Mill Hill Laboratory, London, United Kingdom.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wilkinson
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Jaya S
authors.initials: JS
authors.lastname: Tyagi
authors.affiliation: Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam Nuffield Department of Medicine, University of Oxford, London, United Kingdom.
authors.forename: Guy E
authors.initials: GE
authors.lastname: Thwaites
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis.
authors.forename: David R
authors.initials: DR
authors.lastname: Boulware
mesh_terms: D004269:DNA, Bacterial; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000235:genetics; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D014390:Tuberculosis, Meningeal / Q000175:diagnosis*
chemical_list: D004269:DNA, Bacterial
keywords: diagnosis; guideline; meningitis; perspective; tuberculous