The Microbiological Diagnosis Of Tuberculous Meningitis: Results Of Haydarpasa-1 Study
Tarih
2014Yazar
Erdem, H.
Ozturk-Engin, D.
Elaldi, N.
Gulsun, S.
Sengoz, G.
Crisan, A.
Johansen, I. S.
Inan, A.
Nechifor, M.
Al-Mahdawi, A.
Civljak, R.
Ozguler, M.
Savic, B.
Ceran, N.
Cacopardo, B.
Inal, A. S.
Namiduru, M.
Dayan, S.
Kayabas, U.
Parlak, E.
Khalifa, A.
Kursun, E.
Sipahi, O. R.
Yemisen, M.
Akbulut, A.
Bitirgen, M.
Dulovic, O.
Kandemir, B.
Luca, C.
Parlak, M.
Stahl, J. P.
Pehlivanoglu, F.
Simeon, S.
Ulu-Kilic, A.
Yasar, K.
Yilmaz, G.
Yilmaz, E.
Beovic, B.
Catroux, M.
Lakatos, B.
Sunbul, M.
Oncul, O.
Alabay, S.
Sahin-Horasan, E.
Kose, S.
Shehata, G.
Andre, K.
Alp, A.
Cosic, G.
Gul, H. Cem
Karakas, A.
Chadapaud, S.
Hansmann, Y.
Harxhi, A.
Kirova, V.
Masse-Chabredier, I.
Oncu, S.
Sener, A.
Tekin, R.
Deveci, O.
Karabay, O.
Agalar, C.
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We aimed to provide data on the diagnosis of tuberculous meningitis (TBM) in this largest case series ever reported. The Haydarpasa-1 study involved patients with microbiologically confirmed TBM in Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria and Turkey between 2000 and 2012. A positive culture, PCR or Ehrlich-Ziehl-Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) was mandatory for inclusion of meningitis patients. A total of 506 TBM patients were included. The sensitivities of the tests were as follows: interferon- release assay (Quantiferon TB gold in tube) 90.2%, automated culture systems (ACS) 81.8%, Lowenstein Jensen medium (L-J) 72.7%, adenosine deaminase (ADA) 29.9% and EZNs 27.3%. CSF-ACS was superior to CSF L-J culture and CSF-PCR (p<0.05 for both). Accordingly, CSF L-J culture was superior to CSF-PCR (p<0.05). Combination of L-J and ACS was superior to using these tests alone (p<0.05). There were poor and inverse agreements between EZNs and L-J culture (=-0.189); ACS and L-J culture (=-0.172) (p<0.05 for both). Fair and inverse agreement was detected for CSF-ADA and CSF-PCR (=-0.299, p<0.05). Diagnostic accuracy of TBM was increased when both ACS and L-J cultures were used together. Non-culture tests contributed to TBM diagnosis to a degree. However, due to the delays in the diagnosis with any of the cultures, combined use of non-culture tests appears to contribute early diagnosis. Hence, the diagnostic approach to TBM should be individualized according to the technical capacities of medical institutions particularly in those with poor resources.