Inadequate diagnostics: The case to move beyond the bacilli for detection of meningitis due to mycobacterium tuberculosis

Nathan C. Bahr, Graeme Meintjes, David R. Boulware

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Tuberculosis (TB) meningitis is extremely difficult to diagnose due to its pauci-bacillary disease nature and new techniques are needed. Improved test sensitivity would allow for greater clinician confidence in diagnostic testing and has the potential to improve patient outcomes. Traditional microbiologic and molecular tests for TB meningitis focus on detection of TB bacilli and are inadequate. Smear microscopy is rapid but only ~10–15% sensitive. Culture has 50–60% sensitivity but is slow. Xpert MTB/Rif Ultra is a rapid, automated PCR-based assay with ~70% sensitivity versus clinical case definition. Thus, even the best current testing may miss up to 30% of cases. Clinicians are often left to treat empirically with prolonged regimens with significant side effects or risk a missed case that would result in death. Rather than relying strictly on microbiologic or molecular testing to diagnose TB meningitis, we propose that testing of CSF for biomarkers of host response may have an adjunctive role to play in improving the diagnosis of TB meningitis.

Original languageEnglish (US)
Pages (from-to)755-760
Number of pages6
JournalJournal of medical microbiology
Issue number5
StatePublished - May 2019

Bibliographical note

Funding Information:
D.R.B. is supported by the National Institute of Neurologic Diseases and Stroke (R01NS086312). G.M. is supported by the Wellcome Trust (098316), the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation (NRF) of South Africa (Grant No. 64787), NRF incentive funding (UID: 85858) and the South African Medical Research Council through its TB and HIV Collaborating Centres Programme with funds received from the National Department of Health (RFA# SAMRC-RFA-CC: TB/ HIV/AIDS-01–2014. The opinions, findings and conclusions expressed in this manuscript reflect those of the authors alone.

Publisher Copyright:
© 2019, Microbiology Society. All rights reserved.


  • Delayed diagnosis
  • Diagnostic techniques and procedures
  • Mycobacterium tuberculosis
  • Opportunistic infection
  • Tuberculosis meningitis


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