Cerebrospinal fluid AFB smear in adults with tuberculous meningitis: A systematic review and diagnostic test accuracy meta-analysis

Anna M Stadelman, Kenneth Ssebambulidde, Alexandria Buller, Lillian Tugume, Kyle Yuquimpo, Caitlin J. Bakker, David R. Boulware, Nathan C Bahr

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Cerebrospinal fluid (CSF) Ziehl–Neelsen acid-fast bacilli (AFB) smear is a rapid, cheap, widely available test for tuberculous meningitis (TBM). Yet, reported test sensitivity is highly variable. We performed a systematic review and meta-analysis for CSF AFB smear vs. other mycobacterial tests to diagnose TBM. Methods: We searched MEDLINE and Embase for studies reporting sensitivity and specificity of AFB smear against mycobacterial tests (reference standard) in adults (≥15 years) with suspected TBM. We used the QUADAS-2 tool to assess risk of bias. We estimated pooled sensitivity and specificity of AFB smear versus the reference standard using random-effects bivariate modeling. We used the I2 statistic to assess heterogeneity between studies. Results: Of 981 articles identified, 11 were eligible for inclusion with a total of 1713 participants. Seven studies were from high-TB burden settings and 4 from low-TB burden settings. The pooled sensitivity and specificity of CSF AFB smear were 8% (95%CI 3–21) and 100% (95%CI 90–100), with substantial heterogeneity in diagnostic performance (I2 >95% for both) and reference standards. Conclusion: CSF AFB smear has poor sensitivity in most settings. If other more sensitive tests are available, those should be used preferentially rather than CSF AFB smear.

Original languageEnglish (US)
Article number102230
JournalTuberculosis
Volume135
DOIs
StatePublished - Jul 2022

Bibliographical note

Funding Information:
Fogarty International Center, National Institutes of Health, USA (R01NS086312, D43TW009345). National Institute of Neurological Disorders and Stroke, National Institutes of Health, USA (K23NS110470).

Publisher Copyright:
© 2022 Elsevier Ltd

Keywords

  • Acid-fast bacilli
  • Meta-analysis
  • Systematic review
  • Tuberculous meningitis
  • Ziehl-neelsen stain

PubMed: MeSH publication types

  • Journal Article
  • Meta-Analysis
  • Systematic Review
  • Research Support, N.I.H., Extramural

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