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Tuberculous (TB) meningitis is fatal more than half the time, but this paucibacillary infection remains difficult to diagnose: Microscopy identifies only about 15% of cases, culture (which takes weeks) detects 50% to 60%, and the Xpert MTB/RIF (Xpert) assay finds about 60%. Investigators in Uganda evaluated the diagnostic performance of a new fully automated nested real-time PCR assay, Xpert MTE/RIF Ultra (Xpert Ultra). Cerebrospinal fluid (CSF) samples from meningitis patients negative for cryptococcosis were tested with culture, Xpert, and Xpert Ultra.
Among 129 HIV-infected adults with suspected meningitis, 23 were classified as probable or definite TB meningitis by uniform case definition. Of these, Xpert Ultra identified 70%, Xpert dete…