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    Challenges in the diagnosis of tuberculous meningitis

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    Author
    Foppiano, Palacios, C.
    Saleeb, P.G.
    Date
    2020
    Journal
    Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
    Publisher
    Elsevier Ltd
    Type
    Article
    
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    https://doi.org/10.1016/j.jctube.2020.100164
    Abstract
    Tuberculosis (TB) continues to pose a significant public health problem. Tuberculous meningitis (TBM) is the most severe form of extra-pulmonary TB. TBM carries a high mortality rate, including for those receiving treatment for TB. Diagnosis of TBM is difficult for clinicians as it can clinically present similarly to other forms of meningitis. The difficulty in diagnosis often leads to a delay in treatment and subsequent mortality. Those who survive are left with long-term sequelae leading to lifelong disability. The microbiologic diagnosis of TBM requires the isolation of Mycobacterium tuberculosis from the cerebrospinal fluid (CSF) of an infected patient. The diagnosis of tuberculous meningitis continues to be challenging for clinicians. Unfortunately, many cases of TBM cannot be confirmed based on clinical and imaging findings as the clinical findings are nonspecific, while laboratory techniques are largely insensitive or slow. Until recently, the lack of accessible and timely tests has contributed to a delay in diagnosis and subsequent morbidity and mortality for many patients, particularly those in resourcelimited settings. The availability of Xpert Ultra and point-of-care lipoarabinomannan (LAM) testing could represent a new era of prompt diagnosis and early treatment of tuberculous meningitis. However, clinicians must be cautious when ruling out TBM with Xpert Ultra due to its low negative predictive value. Due to the limitations of current diagnostics, clinicians should utilize a combination of diagnostic modalities in order to prevent morbidity in patients with TBM. Copyright 2020 The Author(s)
    Keyword
    CNS
    Diagnosis
    Diagnostics
    Meningitis
    Tuberculoma
    Tuberculosis
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85084840060&doi=10.1016%2fj.jctube.2020.100164&partnerID=40&md5=246ce89ca5d749b1bc52fb4b413fa28a; http://hdl.handle.net/10713/12899
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jctube.2020.100164
    Scopus Count
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    UMB Open Access Articles 2020

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