Evidence map›Paper›PMID 34485474›Full record

ArticleSouthern African journal of infectious diseases2020

Laboratory diagnosis of tuberculous meningitis in human immunodeficiency virus-seropositive patients: Correlation with the uniform case definition.

Mohammed Mitha, Melendhran Pillay, Julie Y Moodley, Yusentha Balakrishna, Nathlee Abbai, Smita Bhagwan, Zaynah Dangor, Ahmed I Bhigjee

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Southern African journal of infectious diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
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

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Review
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

8 authors.

Mohammed MithaDepartment of Pulmonology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.ORCID https://orcid.org/0000-0003-1916-8201
Melendhran PillayNational Health Laboratory Services Department, University of KwaZulu-Natal, Durban, South Africa.ORCID https://orcid.org/0000-0002-5570-1010
Julie Y MoodleyNational Health Laboratory Services Department, University of KwaZulu-Natal, Durban, South Africa.ORCID https://orcid.org/0000-0002-4743-8857
Yusentha BalakrishnaBiostatistics Unit, South African Medical Research Council, Durban, South Africa.ORCID https://orcid.org/0000-0001-6449-3260
Nathlee AbbaiSchool of Clinical Medicine Research Laboratory, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.ORCID https://orcid.org/0000-0003-2392-0574
Smita BhagwanDepartment of Neurology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.ORCID https://orcid.org/0000-0001-8921-3747
Zaynah DangorDepartment of Neurology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.ORCID https://orcid.org/0000-0002-2316-410X
Ahmed I BhigjeeDepartment of Neurology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.ORCID https://orcid.org/0000-0002-3103-8488

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLaboratory confirmation of the diagnosis of tuberculous meningitis (TBM) has always been problematic. Using the uniform case definition suggested by Marais et al., we determined the sensitivity of a variety of laboratory tests.

methodsHuman immunodeficiency virus (HIV)-seropositive patients suspected of having subacute meningitis were included in the study. Using the uniform case definition, patients were divided into possible and probable cases of TBM. The following specific tests were done on the cerebrospinal fluid (CSF): layered Ziehl-Neelsen (ZN) staining, CSF culture and a panel of nucleic acid amplification tests (NAAT) consisting of the GenoType MTBDRplus assay, Cepheid Xpert MTB/RIF, the MTB Q-PCR Alert (Q-PCR) and the loop-mediated isothermal amplification (LAMP) assay. The sensitivity of each test was compared to the case definition and to each other.

resultsA total of 68 patients were evaluated. Using the uniform case definition only, without any of the specific laboratory tests, there were 15 probable cases (scores > 12) and 53 possible cases (scores 6-11) of TBM. When the uniform case definition was tested against any laboratory test, 12 of the 15 (80%) probable cases and 26 of the 53 (49.1%) possible cases had laboratory confirmation. When each test was compared to any other test, the sensitivities for the Xpert MTB/RIF, GenoType MTBDRplus, CSF culture, Q-PCR, LAMP and ZN layering were 63.2 (46.0-78.2), 76.3 (59.8-88.6), 65.7 (47.8-80.9), 81.1 (64.8-92.0), 70.3 (53.0-84.1) and 55.6 (38.1-72.1), respectively.

conclusionIn this study, the GenoType MTBDRplus and the Q-PCR tests performed better than the Xpert MTB/RIF. Because the Xpert MTB/RIF is not good enough to 'rule out' TBM, a negative result should be followed up by another NAAT, such as the GenoType MTBDRplus or Q-PCR. The LAMP assay may be considered as the first test in resource-poor settings. At the time of the study, we did not have access to the Xpert MTB/RIF Ultra, which has now been recommended by the World Health Organization as the test of first choice. However, even this test has a similar limitation as the Xpert MTB/RIF, with two recent studies showing variable results.

Indexed as

HIVlaboratory diagnosistuberculous meningitisuniform case definitionWorld Health Organization

Identifiers

PMID34485474
PMCPMC8378181

What OpenQuestion holds

Textmetadata
LicenceCC BY
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.