Improving Technology to Diagnose Tuberculous Meningitis: Are We There Yet?
Diagnosis of tuberculous meningitis (TBM) remains challenging due to a paucity of high-performance diagnostics. Even those that have reasonable sensitivity are not adequate to ‘rule out' TBM. Therefore, a combination of clinical factors alongside microbiological, molecular, and radiological inv...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.892224/full |
| _version_ | 1818240510305763328 |
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| author | Kenneth Ssebambulidde Jane Gakuru Jayne Ellis Jayne Ellis Fiona V. Cresswell Fiona V. Cresswell Fiona V. Cresswell Nathan C. Bahr |
| author_facet | Kenneth Ssebambulidde Jane Gakuru Jayne Ellis Jayne Ellis Fiona V. Cresswell Fiona V. Cresswell Fiona V. Cresswell Nathan C. Bahr |
| author_sort | Kenneth Ssebambulidde |
| collection | DOAJ |
| description | Diagnosis of tuberculous meningitis (TBM) remains challenging due to a paucity of high-performance diagnostics. Even those that have reasonable sensitivity are not adequate to ‘rule out' TBM. Therefore, a combination of clinical factors alongside microbiological, molecular, and radiological investigations are utilized, depending on availability. A low threshold for starting empiric therapy in the appropriate clinical scenario remains crucial for good outcomes in many cases. Herein, we review the current TBM diagnostics landscape with a focus on limitations frequently encountered, such as diagnostic test performance, cost, laboratory infrastructure, and clinical expertise. Though molecular technologies, particularly GeneXpert MTB/Rif Ultra, have been a step forward, diagnosis of TBM remains difficult. We also provide an overview of promising technologies, such as cerebrospinal fluid (CSF) lactate, a new lipoarabinomannan test (FujiLAM), metagenomic next-generation sequencing, and transcriptomics that may further improve our TBM diagnostic capacity and lead to better outcomes. |
| first_indexed | 2024-12-12T13:14:35Z |
| format | Article |
| id | doaj.art-94bb15bf4650479a8a00434bacf907f0 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-12T13:14:35Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-94bb15bf4650479a8a00434bacf907f02022-12-22T00:23:27ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-05-011310.3389/fneur.2022.892224892224Improving Technology to Diagnose Tuberculous Meningitis: Are We There Yet?Kenneth Ssebambulidde0Jane Gakuru1Jayne Ellis2Jayne Ellis3Fiona V. Cresswell4Fiona V. Cresswell5Fiona V. Cresswell6Nathan C. Bahr7Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, UgandaClinical Research Department, London School of Hygiene and Tropical Medicine, London, United KingdomInfectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, UgandaClinical Research Department, London School of Hygiene and Tropical Medicine, London, United KingdomGlobal Health and Infection, Brighton and Sussex Medicine School, Brighton, United KingdomDivision of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, United StatesDiagnosis of tuberculous meningitis (TBM) remains challenging due to a paucity of high-performance diagnostics. Even those that have reasonable sensitivity are not adequate to ‘rule out' TBM. Therefore, a combination of clinical factors alongside microbiological, molecular, and radiological investigations are utilized, depending on availability. A low threshold for starting empiric therapy in the appropriate clinical scenario remains crucial for good outcomes in many cases. Herein, we review the current TBM diagnostics landscape with a focus on limitations frequently encountered, such as diagnostic test performance, cost, laboratory infrastructure, and clinical expertise. Though molecular technologies, particularly GeneXpert MTB/Rif Ultra, have been a step forward, diagnosis of TBM remains difficult. We also provide an overview of promising technologies, such as cerebrospinal fluid (CSF) lactate, a new lipoarabinomannan test (FujiLAM), metagenomic next-generation sequencing, and transcriptomics that may further improve our TBM diagnostic capacity and lead to better outcomes.https://www.frontiersin.org/articles/10.3389/fneur.2022.892224/fulltuberculosisTB meningitistuberculous meningitisdiagnostic testingmolecular testingcerebrospinal fluid |
| spellingShingle | Kenneth Ssebambulidde Jane Gakuru Jayne Ellis Jayne Ellis Fiona V. Cresswell Fiona V. Cresswell Fiona V. Cresswell Nathan C. Bahr Improving Technology to Diagnose Tuberculous Meningitis: Are We There Yet? Frontiers in Neurology tuberculosis TB meningitis tuberculous meningitis diagnostic testing molecular testing cerebrospinal fluid |
| title | Improving Technology to Diagnose Tuberculous Meningitis: Are We There Yet? |
| title_full | Improving Technology to Diagnose Tuberculous Meningitis: Are We There Yet? |
| title_fullStr | Improving Technology to Diagnose Tuberculous Meningitis: Are We There Yet? |
| title_full_unstemmed | Improving Technology to Diagnose Tuberculous Meningitis: Are We There Yet? |
| title_short | Improving Technology to Diagnose Tuberculous Meningitis: Are We There Yet? |
| title_sort | improving technology to diagnose tuberculous meningitis are we there yet |
| topic | tuberculosis TB meningitis tuberculous meningitis diagnostic testing molecular testing cerebrospinal fluid |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.892224/full |
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