{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T01:02:12Z","timestamp":1793149332786,"version":"4.5.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2020,9,28]],"date-time":"2020-09-28T00:00:00Z","timestamp":1601251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R01NS086312"],"award-info":[{"award-number":["R01NS086312"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["K23NS110470"],"award-info":[{"award-number":["K23NS110470"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["T32AI055433"],"award-info":[{"award-number":["T32AI055433"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI145437"],"award-info":[{"award-number":["R01AI145437"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["210772\/Z\/18\/Z"],"award-info":[{"award-number":["210772\/Z\/18\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The World Health Organization recommends GeneXpert MTB\/RIF Ultra (Xpert Ultra), a fully automated polymerase chain reaction (PCR) assay, as the initial tuberculous meningitis (TBM) diagnostic test. The assay\u2019s PCR cycle threshold (Ct) values represent the number of PCR cycles required for probe signal to be detected (low Ct value\u2005=\u2005high bacillary load) and may approximate tuberculosis (TB) bacillary load. We measured the relationship between cerebrospinal fluid (CSF) TB bacillary load with mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We prospectively enrolled 102 human immunodeficiency virus (HIV)\u2013positive Ugandans with probable or definite TBM from April 2015 to August 2019. Xpert Ultra Ct tertiles and semi-quantitative categories were separately analyzed as predictors of 2-week mortality. We investigated associations between Ct and baseline clinical and CSF parameters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Subjects with Ct values in the low tertile (ie, high bacillary load) had 57% 2-week mortality\u2014worse than the intermediate (17%) and high (25%) Ct tertiles and Xpert Ultra\u2013negative (30%) probable TBM cases (P\u2005=\u2005.01). In contrast, the reported semi-quantitative Xpert Ultra categorization was less precise; with the medium to low category trending toward worse 2-week survival (42%) compared with very low (28%), trace (26%), and negative (30%) categories (P\u2005=\u2005.48). Ct tertile was significantly associated with baseline CSF lactate (P\u2005=\u2005.03).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>High CSF TB bacillary load, as measured by Xpert Ultra Ct tertile, is associated with an almost 2-fold higher 2-week mortality in HIV-associated TBM and is a better predictor than the reported Xpert Ultra semi-quantitative category. Xpert Ultra Ct values could identify TBM patients at increased risk of death who may benefit from enhanced supportive care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1444","type":"journal-article","created":{"date-parts":[[2020,9,27]],"date-time":"2020-09-27T19:07:32Z","timestamp":1601233652000},"page":"e3505-e3510","source":"Crossref","is-referenced-by-count":15,"title":["Cerebrospinal Fluid Bacillary Load by Xpert MTB\/RIF Ultra Polymerase Chain Reaction Cycle Threshold Value Predicts 2-Week Mortality in Human Immunodeficiency Virus\u2013Associated Tuberculous Meningitis"],"prefix":"10.1093","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4981-9298","authenticated-orcid":false,"given":"Emily M","family":"Martyn","sequence":"first","affiliation":[{"name":"Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananta S","family":"Bangdiwala","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minneapolis, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enock","family":"Kagimu","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morris K","family":"Rutakingirwa","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kasibante","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Okirwoth","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Stead","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Wadda","sequence":"additional","affiliation":[{"name":"Mulago National Referral Hospital, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew F","family":"Pullen","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minneapolis, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler D","family":"Bold","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minneapolis, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B","family":"Meya","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Kampala, Uganda"},{"name":"Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R","family":"Boulware","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minneapolis, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan C","family":"Bahr","sequence":"additional","affiliation":[{"name":"University of Kansas Medical Center, Kansas City, Kansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona V","family":"Cresswell","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Kampala, Uganda"},{"name":"Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,9,28]]},"reference":[{"key":"2021110300161443800_CIT0001","volume-title":"Global tuberculosis report","author":"World Health 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