Predictors of cerebrospinal fluid GeneXpert MTB/RIF positivity in patients with tuberculous meningitis:A prospective cohort study  

作　　者：Priyanka Gupta Neeraj Kumar Ravindra Kumar Garg Hardeep Singh Malhotra Imran Rizvi Rajesh Verma Praveen Kumar Sharma Ravi Uniyal Shweta Pandey Amita Jain Parul Jain 

机构地区：[1]Department of Neurology,King George’s Medical University,Lucknow,India [2]Department of Microbiology,King George’s Medical University,Lucknow,India

出　　处：《Asian Pacific Journal of Tropical Medicine》2024年第10期465-472,共8页亚太热带医药杂志（英文版）

摘　　要：Objective:To identify the clinical,laboratory,and radiological markers that could predict a positive GeneXpert result in patients suspected of tuberculous meningitis.Methods:In this prospective,observational study,patients with tuberculous meningitis were systematically evaluated.Various clinical,laboratory[including cerebrospinal fluid(CSF)microscopy,culture,and GeneXpert],and neuroimaging factors were examined.All participants were administered anti-tuberculous treatment and corticosteroids.A six-month follow-up was done to evaluate the outcome.Results:Of the 116 patients studied,54(46.6%)tested positive for GeneXpert,while 62(53.4%)were negative.Third cranial nerve involvement(OR 3.71,95%CI 1.052-13.09,P=0.04)and the presence of basal exudates on neuroimaging(OR 5.22,95%CI 2.03-13.42,P=0.001)emerged as independent predictive factors for a positive GeneXpert result.A positive CSF GeneXpert result(P=0.002)and drug resistance(P=0.004)were significantly linked to adverse outcomes.Additionally,a high score on the Medical Research Council stageⅢ(OR 5.64,95%CI 1.18-26.87,P=0.03)and elevated CSF cell counts(OR 1.002,95%CI 1.00-1.001,P=0.03)were identified as independent predictors of poor prognosis.Conclusions:Third cranial nerve involvement and the presence of basal exudates were significant indicators of a positive GeneXpert result.MRC stageⅢdisability and elevated CSF cell counts predicted poor outcomes.

关 键 词：Tuberculous meningitis Mycobacterium tuberculosis Cerebrospinal fluid Ziehl-Neelsen staining GeneXpert 

分 类 号：R529.3[医药卫生—内科学]