Skip to main content
Home / The International Journal of Tuberculosis and Lung Disease, Volume 26, Number 4

Performance of Xpert® MTB/RIF and Xpert® Ultra for the diagnosis of tuberculous meningitis in children

Buy Article:

$34.78 + tax (Refund Policy)

OBJECTIVE: To assess Xpert® MTB/RIF (Xpert) and Xpert® MTB/RIF Ultra (Ultra) performance in diagnosing pediatric tuberculous meningitis (TBM).

METHODS: We conducted a study among children with suspected meningoencephalitis in Pune, India. Clinical, radiological, laboratory, and treatment data were analyzed to classify disease as definite, probable, possible or no TBM, using microbiologic or composite reference standards. We tested cerebrospinal fluid (CSF) either using Xpert or Ultra and estimated test performance characteristics.

RESULTS: Of 341 participants, 149 (43.7%) were tested using Ultra and 192 (56.3%) with Xpert. Ultra had higher sensitivity (50% vs. 18%), lower specificity (91% vs. 99%), poor positive predictive value (PPV) (13% vs. 75%), and higher negative predictive value (NPV) (99% vs. 93%) than Xpert using the composite reference standard, with similar results by the microbiologic reference standard. Of 10 participants with trace positivity on Ultra, none met clinical TBM definitions.

CONCLUSION: This is the first study to report on diagnostic performance of Ultra in pediatric TBM, which showed higher sensitivity and NPV than Xpert. For children presenting with nonspecific clinical features, Ultra is a promising diagnostic test. Further studies are required to define its optimal clinical use, including interpretation of trace positive results.

Keywords: Xpert® MTB/RIF; Xpert® MTB/RIF Ultra; cerebrospinal fluid; diagnostics; pediatrics; tuberculous meningitis

Document Type: Research Article

Affiliations: 1: BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India, Johns Hopkins India, Pune, India 2: BJ Government Medical College and Sassoon General Hospitals, Pune, India 3: BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India 4: BJ Government Medical College-Johns Hopkins Clinical Research Site, Pune, India, Johns Hopkins University School of Medicine, Baltimore, MD 5: Johns Hopkins University School of Medicine, Baltimore, MD 6: Department of Neurology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA

Publication date: April 1, 2022

More about this publication?

  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

  • Editorial Board
  • Information for Authors
  • Subscribe to this Title
  • International Journal of Tuberculosis and Lung Disease
  • Public Health Action
  • Ingenta Connect is not responsible for the content or availability of external websites

Share Content

  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content