{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T02:10:10Z","timestamp":1771035010941,"version":"3.50.1"},"reference-count":40,"publisher":"FapUNIFESP (SciELO)","issue":"11","license":[{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Neuro-Psiquiatr."],"abstract":"<jats:p>ABSTRACT  Background: The timely diagnosis of tuberculous meningitis (TBM) is challenging. Molecular diagnostic tools are necessary for TBM, particularly in low- and middle-income countries.  Objectives: We aimed to calculate the diagnostics characteristics of Xpert MTB\/RIF for the detection of Mycobacterium tuberculosis in the cerebrospinal fluid (CSF) and the frequency of rifampicin (RIF)-resistance in the CSF samples.  Methods: A total of 313 consecutive CSF samples were studied and categorized into TBM definite, probable, possible, or not TBM cases based on the clinical, laboratory, and imaging data.  Results: For the definite TBM cases (n=7), the sensitivity, specificity, efficiency, and positive likelihood ratio were 100, 97, 97, and 38%, respectively. However, for the TBM definite associated with the probable cases (n=24), the sensitivity decreased to 46%. All CSF samples that were Xpert MTB\/RIF-positive were RIF susceptible.  Conclusion: Xpert MTB\/RIF showed high discriminating value among the microbiology-proven TBM cases, although the values for the probable and possible TBM cases were reduced. Xpert MTB\/RIF contributes significantly to the diagnosis of TBM, mainly when coupled with the conventional microbiological tests and clinical algorithms.<\/jats:p>","DOI":"10.1590\/0004-282x20200067","type":"journal-article","created":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T19:30:01Z","timestamp":1607974201000},"page":"700-707","source":"Crossref","is-referenced-by-count":8,"title":["Diagnostic characteristics of Xpert MTB\/RIF assay for the diagnosis of tuberculous meningitis and rifampicin resistance in Southern Brazil"],"prefix":"10.1590","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5690-105X","authenticated-orcid":false,"given":"Sergio Monteiro","family":"de Almeida","sequence":"first","affiliation":[{"name":"Universidade Federal do Paran\u00e1,  Brazil; Universidade Federal do Paran\u00e1,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4549-4094","authenticated-orcid":false,"given":"Gislene Maria Bot\u00e3o","family":"Kussen","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0469-8883","authenticated-orcid":false,"given":"Laura","family":"Cogo","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6944-9215","authenticated-orcid":false,"given":"Jos\u00e9 Henrique","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5655-9645","authenticated-orcid":false,"given":"Keite","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2020,11]]},"reference":[{"key":"ref1","series-title":"International neurology, a clinical approach","first-page":"258","volume-title":"Mycobacterium tuberculosis","author":"Wilder-Smith EP","year":"2009"},{"key":"ref2","series-title":"Resolutions and decisions","first-page":"25","volume-title":"Prevention and control of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis. 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and meta-analysis of the diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis","volume":"57","author":"Pormohammad A","year":"2019","journal-title":"J Clin Microbiol"},{"issue":"11","key":"ref7","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/S1473-3099(10)70138-9","article-title":"Tuberculous meningitis: a uniform case definition for use in clinical research","volume":"10","author":"Marais S","year":"2010","journal-title":"Lancet Infect Dis"},{"key":"ref8","series-title":"Public health mycobacteriology: a guide for the level III laboratory","author":"Kent PT","year":"1985"},{"key":"ref9","series-title":"Beyond normality, the predictive value and efficiency of medical diagnoses","author":"Galen RS","year":"1975"},{"issue":"11","key":"ref10","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1002\/gps.2053","article-title":"The clinical significance of subjective memory complaints in the diagnosis of mild cognitive impairment and dementia: a meta-analysis","volume":"23","author":"Mitchell AJ","year":"2008","journal-title":"Int J Geriatr Psychiatry"},{"issue":"3","key":"ref11","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s10654-011-9561-x","article-title":"Sensitivity x PPV is a recognized test called the clinical utility index (CUI+)","volume":"26","author":"Mitchell AJ","year":"2011","journal-title":"Eur J Epidemiol"},{"issue":"4","key":"ref12","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1111\/j.1651-2227.2006.00179.x","article-title":"Understanding diagnostic tests 2: likelihood ratios, pre- and post-test probabilities and their use in clinical practice","volume":"96","author":"Akobeng AK","year":"2007","journal-title":"Acta Paediatr"},{"issue":"8","key":"ref13","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1046\/j.1525-1497.2002.10750.x","article-title":"Simplifying likelihood ratios","volume":"17","author":"McGee S","year":"2002","journal-title":"J Gen Intern Med"},{"issue":"5","key":"ref14","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1111\/j.1651-2227.2006.00178.x","article-title":"Understanding diagnostic tests 3: receiver operating characteristic curves","volume":"96","author":"Akobeng AK","year":"2007","journal-title":"Acta Paediatr"},{"issue":"7336","key":"ref15","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1136\/bmj.324.7336.539","article-title":"The architecture of diagnostic research","volume":"324","author":"Sackett DL","year":"2002","journal-title":"BMJ"},{"issue":"5","key":"ref16","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1056\/NEJM197507312930513","article-title":"Letter: nomogram for Bayes theorem","volume":"293","author":"Fagan TJ","year":"1975","journal-title":"N Engl J Med"},{"issue":"1","key":"ref17","doi-asserted-by":"crossref","first-page":"78","DOI":"10.4103\/lungindia.lungindia_98_17","article-title":"Multidrug-resistant tuberculosis\/rifampicin-resistant tuberculosis: 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Med"},{"issue":"4","key":"ref27","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1515\/cclm-2018-0524","article-title":"Validation of Mycobacterium tuberculosis real-time polymerase chain reaction for diagnosis of tuberculous meningitis using cerebrospinal fluid samples: a pilot study","volume":"57","author":"de Almeida SM","year":"2019","journal-title":"Clin Chem Lab Med"},{"issue":"7-8","key":"ref28","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.neurol.2019.07.007","article-title":"Tuberculous meningitis: challenges in diagnosis and management","volume":"175","author":"M\u00e9cha\u00ef F","year":"2019","journal-title":"Rev Neurol"},{"key":"ref29","first-page":"CD013359","article-title":"Xpert MTB\/RIF and Xpert MTB\/RIF Ultra assays for active tuberculosis and rifampicin resistance in children","volume":"8","author":"Kay AW","year":"2020","journal-title":"Cochrane Database Syst 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