Evidence map›Paper›PMID 26459535›Full record

ArticleThe international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease2015

Improved diagnostic sensitivity for tuberculous meningitis with Xpert(®) MTB/RIF of centrifuged CSF.

N C Bahr, L Tugume, R Rajasingham, R Kiggundu, D A Williams, B Morawski, D Alland, D B Meya, J Rhein, D R Boulware

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 78 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
78citing papers in PubMed, 10 pooled it
9.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

78 citing papers in PubMed, 10 syntheses or guidelines pooled it, 110 citations in OpenAlex.

  1. A clinical practice guideline for tuberculous meningitis.The Lancet. Infectious diseases · 2026
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  10. XpertThe Cochrane database of systematic reviews · 2018
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18 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 2 institutions in 2 countries.

N C BahrDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, USA; Center for Infectious Diseases & Microbiology Translational Research, University of Minnesota, Minneapolis, Minnesota, USA; Infectious Disease Institute, Makerere University, Kampala, Uganda.
L TugumeInfectious Disease Institute, Makerere University, Kampala, Uganda.
R RajasinghamDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, USA.
R KiggunduInfectious Disease Institute, Makerere University, Kampala, Uganda.
D A WilliamsDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, USA; Infectious Disease Institute, Makerere University, Kampala, Uganda.
B MorawskiDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, USA; Center for Infectious Diseases & Microbiology Translational Research, University of Minnesota, Minneapolis, Minnesota, USA.
D AllandCenter for Infectious Disease, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA.
D B MeyaDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, USA; Infectious Disease Institute, Makerere University, Kampala, Uganda; School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
J RheinDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, USA; Center for Infectious Diseases & Microbiology Translational Research, University of Minnesota, Minneapolis, Minnesota, USA, Infectious Disease Institute, Makerere University, Kampala, Uganda.
D R BoulwareDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, USA; Center for Infectious Diseases & Microbiology Translational Research, University of Minnesota, Minneapolis, Minnesota, USA.
Makerere University · UGUniversity of Minnesota · US

Funding

Improving Diagnostics and Neurocognitive Outcomes in HIV/AIDS-related MeningitisR01NS086312 · NINDS · UNIVERSITY OF MINNESOTA · PI David R Boulware, David Bisagaya Meya · 2013 to 2026
$8.3M
Infectious Disease Training in Clinical InvestigationT32AI055433 · NIAID · UNIVERSITY OF MINNESOTA TWIN CITIES · PI David R Boulware · 2003 to 2026
$6.1M
Northern/Pacific Universities Global Health Research Training ConsortiumR25TW009345 · FIC · UNIVERSITY OF WASHINGTON · PI KOLARS, JOSEPH C., NERURKAR, VIVEK RAMCHANDRA · 2012 to 2016
$5.9M
FIC NIH HHS R25 TW009345FIC NIH HHS R25TW009345NIAID NIH HHS T32 AI055433NIAID NIH HHS T32AI055433NINDS NIH HHS R01 NS086312NINDS NIH HHS R01NS086312
6 · The paper itself

Abstract

backgroundTB meningitis (TBM) diagnosis is difficult and novel diagnostic methods are needed. The World Health Organization recommends Xpert(®) MTB/RIF as the initial TBM diagnostic test based on two studies reporting suboptimal sensitivity (~50-60%).

objectiveTo study the effect of cerebrospinal fluid (CSF) centrifugation on Xpert performance for TBM detection.

designA total of 107 predominantly human immunodeficiency virus (HIV) infected adults with presumed meningitis were screened prospectively in Kampala, Uganda. CSF was tested using 1) microscopy for acid-fast bacilli; 2) MGIT™ culture; 3) Xpert of 2 ml of unprocessed CSF; and 4) Xpert of centrifuged CSF. Diagnostic performance was measured against an a priori composite reference standard of any positive CSF tuberculosis test.

resultsOf 107 participants, 18 (17%) had definite TBM. When CSF was centrifuged, Xpert had better sensitivity (13/18, 72%) than when using 2 ml of unprocessed CSF (5/18, 28%; P = 0.008). The median centrifuged CSF volume was 6 ml (IQR 4-10). Mycobacterial culture yielded 71% (12/17) sensitivity at a median delay of 27 days. Only 39% were positive by both culture and centrifuged Xpert, with additional cases detected by Xpert and culture.

conclusionsCSF centrifugation optimizes the diagnostic performance of Xpert in the detection of TBM. A combination of culture and Xpert detected the largest number of cases.

Indexed as

AdultCentrifugationCohort StudiesFemaleHIV InfectionsHumansMaleMicroscopyMiddle AgedMolecular Diagnostic TechniquesProspective StudiesSensitivity and SpecificityTuberculosis, MeningealUganda

Identifiers

PMID26459535
PMCPMC4768484
OpenAlexW2338031983

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.