{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T20:18:29Z","timestamp":1791663509287,"version":"4.3.4"},"reference-count":69,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T00:00:00Z","timestamp":1606694400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>This systematic review evaluated the diagnostic accuracy of Xpert MTB\/RIF to detect tuberculous meningitis (TBM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>PubMed and five other databases were systematically searched through March 2019. All studies evaluating diagnostic accuracy of Xpert MTB\/RIF on cerebrospinal fluid (CSF) samples were included. Reference standards were definitive or definite plus probable TBM. The quality of studies was assessed by the QUADAS\u20102 tool. We performed bivariate random\u2010effects meta\u2010analysis and calculated summary diagnostic statistics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 30 studies (<jats:italic>n<\/jats:italic>\u00a0=\u00a03972 participants), including 5 cohort studies and 25 cross\u2010sectional studies. Reference standards were definite TB (<jats:italic>n<\/jats:italic>\u00a0=\u00a028 studies) or definite plus probable TBM (<jats:italic>n<\/jats:italic>\u00a0=\u00a06 studies). The pooled Xpert MTB\/RIF sensitivity was 85% (95% CI, 70\u201393%), and specificity was 98% (95% CI, 97\u201399%) with a negative likelihood ratio of 0.15 (95% CI, 0.04\u20130.27) for definite TBM. For probable TBM cases, pooled sensitivity was 81% (95% CI, 66\u201390%), and specificity was 99% (95% CI, 97\u201399%).\u00a0For both reference standard types, meta\u2010analyses showed a C\u2010statistic area under the curve of 0.98. The QUADAS\u20102 tool revealed low risk of bias as well as low concerns regarding applicability. Methodological heterogeneity was high among studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Xpert MTB\/RIF showed high accuracy for TBM diagnosis, but a negative Xpert MTB\/RIF test does not rule out TBM. Repeat Xpert testing may be necessary. In clinical practice, Xpert MTB\/RIF adds speed and sensitivity when compared to classic TBM diagnostic methods or previous commercial nucleic acid amplification techniques. More studies and better strategies for rapidly confirming a diagnosis of TBM in children are urgently needed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13525","type":"journal-article","created":{"date-parts":[[2020,11,9]],"date-time":"2020-11-09T06:25:47Z","timestamp":1604903147000},"page":"122-132","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Diagnostic accuracy of Xpert MTB\/RIF for tuberculous meningitis: systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"26","author":[{"given":"Adrian V.","family":"Hernandez","sequence":"first","affiliation":[{"name":"University of Connecticut\/Hartford Hospital Evidence\u2010based Practice Center Hartford CT USA"},{"name":"Vicerrectorado de Investigaci\u00f3n Universidad San Ignacio de Loyola (USIL) Lima Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laryssa","family":"de Laurentis","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Instituto de Infectologia Em\u00edlio Ribas S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isadora","family":"Souza","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Instituto de Infectologia Em\u00edlio Ribas S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo","family":"Pessanha","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Instituto de Infectologia Em\u00edlio Ribas S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyaleela","family":"Thota","sequence":"additional","affiliation":[{"name":"Hemex Health Inc. Portland OR USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuani M.","family":"Roman","sequence":"additional","affiliation":[{"name":"University of Connecticut\/Hartford Hospital Evidence\u2010based Practice Center Hartford CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshuan","family":"Barboza\u2010Meca","sequence":"additional","affiliation":[{"name":"Vicerrectorado de Investigaci\u00f3n Universidad San Ignacio de Loyola (USIL) Lima Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Boulware","sequence":"additional","affiliation":[{"name":"Department of Medcine University of Minnesota Minneapolis MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose E.","family":"Vidal","sequence":"additional","affiliation":[{"name":"Department of Neurology Instituto de Infectologia Em\u00edlio Ribas S\u00e3o Paulo Brazil"},{"name":"Department of Infectious Diseases Hospital das Cl\u00ednicas Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,30]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.19.1.20714"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001400"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.17.1.19184"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0163036"},{"key":"e_1_2_6_6_1","unstructured":"HarriesA MaherD GrahamS.TB\/HIV: a clinical manual. World Health Organization. (WHO\/HTM\/TB\/2004.329). (Available from:http:\/\/whqlibdoc.who.int\/publications\/2004\/9241546344.pdf). Accessed Feb 05 2020."},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-14-9"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-10-67"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31828e1e56"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-010-5744-8"},{"key":"e_1_2_6_11_1","first-page":"831292","article-title":"The PCR\u2010based diagnosis of central nervous system tuberculosis: up to date","volume":"2012","author":"Takahashi T","year":"2012","journal-title":"Tuberc Res Treat"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2010.02565.x"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.17.0001"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2017.120"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30474-7"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(03)00772-2"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2014.01.002"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001537"},{"key":"e_1_2_6_19_1","unstructured":"WHO.Automated real\u2010time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB\/RIF assay for the diagnosis of pulmonary and extrapulmonary tuberculous in adults and children. Policy update.World Health Organization:Geneva;2013."},{"key":"e_1_2_6_20_1","unstructured":"WHO.Global tuberculosis report 2014.World Health Organization:Geneva 2014. (Available from:https:\/\/www.who.int\/tb\/publications\/global_report\/gtbr14_executive_summary.pdf) [05 Feb 2020]."},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2019.03.021"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.19163"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(10)70138-9"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-8-201110180-00009"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-019-0724-x"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00211-11"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02319-10"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.06467-11"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00176311"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-13-31"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmyco.2013.05.003"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01235-14"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00624-15"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.14.0500"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.14.0394"},{"key":"e_1_2_6_36_1","first-page":"304","article-title":"Performance of real\u2010time PCR Xpert (R)MTB\/RIF in diagnosing extrapulmonary tuberculosis","volume":"24","author":"Mazzola E","year":"2016","journal-title":"Infez Med"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.15.0849"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.7705\/biomedica.v36i3.3088"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02806-15"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep25251"},{"key":"e_1_2_6_41_1","first-page":"599","article-title":"Evaluation of Xpert MTB\/RIF for the diagnosis of extrapulmonary tuberculosis in China","volume":"29","author":"Yuan M","year":"2016","journal-title":"Biomed Environ Sci"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.4067\/s0716-10182017000400333"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2017.04.010"},{"key":"e_1_2_6_44_1","first-page":"4847","article-title":"Evaluation of Xpert MTB\/RIF in detection of pulmonary and extrapulmonary tuberculosis cases in China","volume":"10","author":"Jing H","year":"2017","journal-title":"Int J Clin Exp Pathol."},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.000522"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pathol.2016.10.004"},{"key":"e_1_2_6_47_1","first-page":"870","article-title":"Potential use of multiplex PCR in diagnosis of tuberculous meningitis","volume":"34","author":"Philip N","year":"2017","journal-title":"Trop Biomed."},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.000449"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.18.0191"},{"key":"e_1_2_6_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2018.01.004"},{"key":"e_1_2_6_51_1","doi-asserted-by":"publisher","DOI":"10.1093\/tropej\/fmy005"},{"key":"e_1_2_6_52_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/8207098"},{"key":"e_1_2_6_53_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0198695"},{"key":"e_1_2_6_54_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-018-0770-x"},{"key":"e_1_2_6_55_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00007814"},{"key":"e_1_2_6_56_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-014-0709-7"},{"key":"e_1_2_6_57_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.14.0262"},{"key":"e_1_2_6_58_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01113-18"},{"key":"e_1_2_6_59_1","first-page":"CD012768","article-title":"Xpert((R)) MTB\/RIF assay for extrapulmonary tuberculosis and rifampicin resistance","volume":"8","author":"Kohli M","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2018.09.003"},{"key":"e_1_2_6_61_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.12688\/wellcomeopenres.14610.1","article-title":"Can improved diagnostics reduce mortality from Tuberculous meningitis? Findings from a 6.5\u2010year cohort in Uganda","volume":"3","author":"Cresswell FV","year":"2018","journal-title":"Wellcome Open Res"},{"key":"e_1_2_6_62_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.15.0253"},{"key":"e_1_2_6_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(19)30550-X"},{"key":"e_1_2_6_64_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw083"},{"key":"e_1_2_6_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurol.2019.07.007"},{"key":"e_1_2_6_66_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00249-19"},{"key":"e_1_2_6_67_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2019.02.010"},{"key":"e_1_2_6_68_1","unstructured":"WHO.WHO Meeting Report of a Technical Expert Consultation: non\u2010inferiority analysis of Xpert MTB\/RIF Ultra compared to Xpert MTB\/RIF.World Health Organization:Geneva 2017a. (Available from:https:\/\/www.who.int\/tb\/publications\/2017\/XpertUltra\/en\/) [05 Feb 2020]."},{"key":"e_1_2_6_69_1","unstructured":"WHO.Frequently asked questions about the WHO Technical Expert Consultation findings on Xpert MTB\/RIF Ultra. March 24 2017b. (Available from:http:\/\/www.who.int\/tb\/areas\u2010of\u2010work\/laboratory\/diagnostics\/XpertUltraFAQs.pdf) [05 Feb 2020]."},{"key":"e_1_2_6_70_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa473"}],"container-title":["Tropical Medicine &amp; International Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tmi.13525","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/tmi.13525","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tmi.13525","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,3]],"date-time":"2023-09-03T16:57:59Z","timestamp":1693760279000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tmi.13525"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,30]]},"references-count":69,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,2]]}},"alternative-id":["10.1111\/tmi.13525"],"URL":"https:\/\/doi.org\/10.1111\/tmi.13525","archive":["Portico"],"relation":{},"ISSN":["1360-2276","1365-3156"],"issn-type":[{"value":"1360-2276","type":"print"},{"value":"1365-3156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,30]]},"assertion":[{"value":"2020-11-30","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}