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Methods of Microbiological Confirmation in Tuberculous Meningitis

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Tuberculosis of the Central Nervous System

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Abstract

Early diagnosis and treatment of tuberculous meningitis (TBM) are essential to have a favourable treatment outcome. Demonstration of acid-fast bacilli in cerebrospinal fluid (CSF) smear is still one of the most dependable methods of diagnosis. Culture of CSF, though considered as most definitive diagnostic method, has limitation and is recommended when detection of drug resistance or characterization of mycobacterial species is required. Nonconventional culture and drug susceptibility methods are not evaluated enough for their clinical utility in extra-pulmonary tuberculosis cases including TBM. Nucleic acid amplification tests (NAATs) promise a rapid, definitive diagnosis of TBM; however, the performance of first-generation NAATs is suboptimal and variable. None of in-house or commercial NAAT assays are endorsed by the World Health Organization (WHO). The Xpert MTB/RIF test, the only WHO-endorsed point-of-care NAAT-based assay, is useful in determining that a patient has TBM. It is not useful in determining that a patient does not have TBM. There is a need to look for more rapid, economical, specific and sensitive assay for laboratory confirmation of TBM.

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Abbreviations

ADA:

Adenosine deaminase activity

AFB:

Acid-fast bacilli

CNS:

Central nervous system

CRI:

Colourimetric redox indicator

CSF:

Cerebrospinal fluid

DNA:

Deoxyribonucleic acid

DST:

Drug susceptibility testing

ELISA:

Enzyme-linked immunosorbent assay

FRET:

Fluorescence resonance energy transfer

HIV:

Human immunodeficiency virus

IGRA:

Interferon gamma release assays

kDA:

Kilodalton

LED:

Fluorescent light-emitting diode

LJ:

Lowenstein–Jensen

LPA:

Line probe assay

MDR:

Multidrug resistance

MGIT:

Mycobacterium growth indicator tube

MODS:

Microscopic observation drug suscep​tibility

MTBC:

Mycobacterium tuberculosis complex

NAATs:

Nucleic acid amplification tests

NRA:

Nitrate reductase assay

NTM:

Non-tuberculous mycobacteria

PCR:

Polymerase chain reaction

REMA:

Resazurin microtitre assay

TB:

Tuberculosis

TBM:

Tuberculous meningitis

WHO:

World Health Organization

XDR:

Extensively drug resistance

ZN:

Ziehl–Neelsen

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  1. Department of Microbiology, King George’s Medical University, Lucknow, UP, India

    Amita Jain MD

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  1. Adnan Menderes University, School of Medicine, Aydın, Turkey

    Mehmet Turgut

  2. Mohammed V University in Rabat, Avicenne Military Hospital of Marrakech, Rabat, Morocco

    Ali Akhaddar

  3. Hacettepe University, School of Medicine, Ankara, Turkey

    Ahmet T. Turgut

  4. King George Medical University, Lucknow, Uttar Pradesh, India

    Ravindra K. Garg

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Jain, A. (2017). Methods of Microbiological Confirmation in Tuberculous Meningitis. In: Turgut, M., Akhaddar, A., Turgut, A., Garg, R. (eds) Tuberculosis of the Central Nervous System. Springer, Cham. https://doi.org/10.1007/978-3-319-50712-5_26

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