ArticleThe Journal of infection2018
Improving the microbiological diagnosis of tuberculous meningitis: A prospective, international, multicentre comparison of conventional and modified Ziehl-Neelsen stain, GeneXpert, and culture of cerebrospinal fluid.
Article in The Journal of infection, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers, 9 of them syntheses that pooled 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.
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.
Who cites it
58 citing papers in PubMed, 9 syntheses or guidelines pooled it, 109 citations in OpenAlex.
- A clinical practice guideline for tuberculous meningitis.The Lancet. Infectious diseases · 2026Guideline
- Diagnostic Prediction Model for Tuberculous Meningitis: An Individual Participant Data Meta-Analysis.The American journal of tropical medicine and hygiene · 2024Pooled it
- Diagnostic value of the cerebrospinal fluid lipoarabinomannan assay for tuberculous meningitis: a systematic review and meta-analysis.Frontiers in public health · 2023Pooled it
- A systematic review and meta-analysis of the diagnostic accuracy of metagenomic next-generation sequencing for diagnosing tuberculous meningitis.Frontiers in immunology · 2023Pooled it
- Diagnostic Accuracy of Interferon-Gamma Release Assays for Tuberculous Meningitis: A Systematic Review and Meta-Analysis.Frontiers in cellular and infection microbiology · 2022Pooled it
- Diagnostic accuracy of Xpert MTB/RIF for tuberculous meningitis: systematic review and meta-analysis.Tropical medicine & international health : TM & IH · 2021Pooled it
- Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults.The Cochrane database of systematic reviews · 2021Pooled it
- Pooled analysis of the Xpert MTB/RIF assay for diagnosing tuberculous meningitis.Bioscience reports · 2020Pooled it
- Diagnostic Accuracy of T-SPOT.TB Assay for Tuberculous Meningitis: An Updated Meta-Analysis.Frontiers in neurology · 2020Pooled it
- Etiologic diagnosis of suspected tuberculous meningitis by multiplex PCR of cerebrospinal fluid.Journal of clinical microbiology · 2026Article
- Comparison of diagnostic accuracy and sensitivity of Kinyoun and auramine-rhodamine stains in detecting mycobacteria from specimen smears.Microbiology spectrum · 2026Article
- Machine learning models based on laboratory data: new insight into the differential diagnosis of tuberculous and viral meningitis.Frontiers in cellular and infection microbiology · 2026Article
- A nested PCR-based point-of-care multiplex test for detection of bacterial pathogens in cerebrospinal fluids.Frontiers in cellular and infection microbiology · 2026Article
- Miliary Tuberculosis: A Comprehensive Review of Epidemiology, Clinical Manifestations, Diagnosis, Treatment, and Complications.Infection and drug resistance · 2026Review
- Meningitis diagnosis, treatment, and outcomes in rural, northern Uganda: 2015-2024.PLOS global public health · 2026Article
- Article
- Molecular diagnostics in cerebrospinal fluid for the diagnosis of central nervous system infections.Clinical microbiology reviews · 2024Review
- A novel diagnostic model for tuberculous meningitis using Bayesian latent class analysis.BMC infectious diseases · 2024Observational
- Interactions between CNS and immune cells in tuberculous meningitis.Frontiers in immunology · 2024Review
- Tuberculous meningitis diagnosis and treatment: classic approaches and high-throughput pathways.Frontiers in immunology · 2024Review
Corrections and comments
- Commented on by
Authors and funding
23 authors at 6 institutions in 6 countries.
Funding
Abstract
objectivesTuberculous meningitis (TBM) is the severest form of tuberculosis, but current diagnostic tests are insensitive. Recent reports suggest simple modifications to conventional cerebrospinal fluid (CSF) Ziehl-Neelsen (ZN) staining may greatly improve sensitivity. We sought to define the performance of modified and conventional ZN stain for TBM diagnosis.
methodsIn hospitals in Vietnam, South Africa and Indonesia we conducted a prospective study of modified ZN with or without cytospin, conventional ZN smear, GeneXpert, and culture on CSF in adults with suspected TBM.
resultsA total of 618 individuals were enrolled across 3 sites. Compared with the TBM clinical diagnostic gold standard for research (definite probable or possible TBM), sensitivity of conventional ZN and modified ZN with cytospin were 33.9% and 34.5% respectively (p = 1.0 for the difference between tests), compared with culture 31.8% and Xpert 25.1%. Using culture as a reference, sensitivities of conventional ZN, modified ZN with cytospin, and Xpert were 66.4%, 67.5%, and 72.3%, respectively. Higher CSF volume and lactate, and lower CSF:blood glucose ratio were independently associated with microbiologically confirmed TBM.
conclusionsModified ZN stain does not improve diagnosis of TBM. Currently available tests are insensitive, but testing large CSF volumes improves performance. New diagnostic tests for TBM are urgently required.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.