Tuberculous meningitis: performance assessment of Xpert MTB/RIF Ultra for diagnosis




Tuberculous meningitis; Cerebrospinal fluid; Diagnosis.


Objective: To evaluate the diagnostic performance of Xpert MTB/RIF Ultra for tuberculous meningitis in cerebrospinal fluids samples. Methodology: This is a retrospective quantitative cross-sectional study developed from information obtained from the records of the Mycobacteria section of the Laboratório Estadual de Saúde Pública Dr. Giovanni Cysneiros – LACEN-GO from November 2019 to January 2021. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and their respective 95% confidence intervals were calculated. Results: A total of 247 cerebrospinal fluid samples were included in the study during the period analyzed, with Mycobacterium tuberculosis Complex (MTC) growing in solid culture in two (0.8%) samples and Xpert MTB/RIF Ultra detected 11 (4.5%) samples with genetic material and, according to the technique, the results obtained were classified into: trace (n= 6), very low (n= 1) and low (n= 4). When evaluating the performance of Xpert, the sensitivity was 100% (95% CI 16-100), 96% specificity (95% CI 93-98), 18% PPV (95% CI 18-30) and 100% NPV (CI 95% 100-100). Conclusion: Xpert MTB/RIF Ultra had a high sensitivity and specificity for the diagnosis of tuberculous meningitis, although the latter was been slightly reduced. These results demonstrate that Xpert MTB/RIF Ultra presents improvements that significantly contribute to the identification of cases of tuberculous meningitis.


Arend, S.M & Soolingen, D.V . (2017) . Performance of Xpert MTB/RIF Ultra: a matter of dead or alive. The Lancet Infectious Diseases , 18 (1) , 8-10 .

Bahr, N. C., Nuwagira, E., Evans, E. E., Cresswell, F. V., Bystrom, P. V., Byamukama, A., Bridge, S. C., Bangdiwala, A. S., Meya, D. B., Denkinger, C. M., Muzoora, C., Boulware, D. R., & ASTRO-CM Trial Team (2018). Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in HIV-infected adults: a prospective cohort study. The Lancet Infectious diseases, 18(1), 68–75.

Bisognin, F., Lombardi, G., Lombardo, D., Re, M.C., & Monte, P.D. (2018). Improvement of Mycobacterium tuberculosis detection by Xpert MTB/RIF Ultra: A head-to-head comparison on Xpert-negative samples. PloS One, 13(8), e0201934.

Chakravorty, S., Simmons, A. M., Rowneki, M., Parmar, H., Cao, Y., Ryan, J., Banada, P. P., Deshpande, S., Shenai, S., Gall, A., Glass, J., Krieswirth, B., Schumacher, S. G., Nabeta, P., Tukvadze, N., Rodrigues, C., Skrahina, A., Tagliani, E., Cirillo, D. M., Davidow, A., & Alland, D. (2017). The New Xpert MTB/RIF Ultra: Improving Detection of Mycobacterium tuberculosis and Resistance to Rifampin in an Assay Suitable for Point-of-Care Testing. mBio, 8(4), e00812-17.

Chin, J. H., Musubire, A. K., Morgan, N., Pellinen, J., Grossman, S., Bhatt, J. M., Wadda, V., & Ssengooba, W. (2019a). Xpert MTB/RIF Ultra for Detection of Mycobacterium tuberculosis in Cerebrospinal Fluid. Journal of clinical microbiology, 57(6), e00249-19.

Chin, J. H., Ssengooba, W., Grossman, S., Pellinen, J., & Wadda, V. (2019b). Xpert MTB / RIF Ultra: Procedimentos ideais para a detecção de Mycobacterium tuberculosis no líquido cefalorraquidiano. Journal of Clinical Tuberculosis and Other Mycobacterial Disease , 14 , 16-18.

Costa, R.R., Silva, M.R., & Gonçalves, I.C. (2018). Diagnóstico laboratorial da tuberculose: Revisão de literatura. Revista Médica de Minas Gerais, 28 (5), e-S280525.

Cresswell, F. V., Tugume, L., Bahr, N. C., Kwizera, R., Bangdiwala, A. S., Musubire, A. K., Rutakingirwa, M., Kagimu, E., Nuwagira, E., Mpoza, E., Rhein, J., Williams, D. A., Muzoora, C., Grint, D., Elliott, A. M., Meya, D. B., Boulware, D. R., & ASTRO-CM team (2020). Xpert MTB/RIF Ultra for the diagnosis of HIV-associated tuberculous meningitis: a prospective validation study. The Lancet Infectious diseases, 20(3), 308–317.

Dietz, J.C., Borges, M.S., Alves, S.L.A., Dias, D.X.R., & Manrique, E.J.C. (2021). Desempenho do teste Xpert® MTB/RIF na detecção laboratorial de tuberculose em amostras pulmonares e extrapulmonares. Research, Society and Development, 10 (7), e36610716533.

Donovan, J., Thu, D., Phu, N. H., Dung, V., Quang, T. P., Nghia, H., Oanh, P., Nhu, T. B., Chau, N., Ha, V., Hang, V., Trinh, D., Geskus, R. B., Tan, L. V., Thuong, N., & Thwaites, G. E. (2020). Xpert MTB/RIF Ultra versus Xpert MTB/RIF for the diagnosis of tuberculous meningitis: a prospective, randomised, diagnostic accuracy study. The Lancet Infectious diseases, 20(3), 299–307.

Garcia, M. L., Dantas, J. M. C., Malheiro, D. R., Moreira, Í. C., & Lucena, M. M. (2016). Meningite Tuberculosa: Perfil epidemiológico no Brasil, no Ceará e no Cariri entre 2007 e 2015. Revista e-Ciência, 4(1).

Garg R. K. (2019). Microbiological diagnosis of tuberculous meningitis: Phenotype to genotype. The Indian journal of medical research, 150(5), 448–457.

Huang, M., Wang, G., Sun, Q., Jiang, G., Li, W., Ding, Z., Jia, H., Gao, M., Huang, H., & Li, Q. (2021). Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in a clinical practice setting of China. Diagnostic Microbiology and Infectious Disease, 100(1):115306.

Kohli, M., Schiller, I., Dendukuri, N., Dheda, K., Denkinger, C. M., Schumacher, S. G., & Steingart, K. R. (2018). Xpert® MTB/RIF assay for extrapulmonary tuberculosis and rifampicin resistance. The Cochrane database of systematic reviews, 8 (8), CD012768.

Opota, O., Mazza-Stalder, J., Greub, G., & Jaton, K. (2019). The rapid molecular test Xpert MTB/RIF ultra: towards improved tuberculosis diagnosis and rifampicin resistance detection. Clinical Microbiology and Infection, 25(11), 1370-1376.

Pereira, A. S., Shitsuka, D. M., Parreira, F. J., & Shitsuka, R. (2018). Metodologia da Pesquisa Científica. Santa Maria, RS: UFSM, NTE.

Seddon, J. A., Tugume, L., Solomons, R., Prasad, K., Bahr, N. C., & Tuberculous Meningitis International Research Consortium (2019). The current global situation for tuberculous meningitis: epidemiology, diagnostics, treatment and outcomes. Wellcome open research, 4 (167).

Seddon, J. A., Thwaites, G. E., & Tuberculous Meningitis International Research Consortium (2019). Tuberculous meningitis: new tools and new approaches required. Wellcome open research, 4 (181).

Shao, L., Qiu, C., Zheng, L., Yang, Y., Yang, X., Liang, Q., Zhang, Y., Che, N., Pang, Y., Duan, H. (2020). Comparison of diagnostic accuracy of the GeneXpert Ultra and cell-free nucleic acid assay for tuberculous meningitis: A multicentre prospective study. International Journal of Infectious Diseases, 98, 441- 446.

World Health Organization. (‎2017)‎. WHO meeting report of a technical expert consultation: non-inferiority analysis of Xpert MTB/RIF ultra compared to Xpert MTB/RIF. World Health Organization.

World Health Organization. (2021). Global tuberculosis report 2021.

Zhang, Y., Huang, J., & Du, L. (2017). The top-cited systematic reviews/meta-analyses in tuberculosis research: A PRISMA-compliant systematic literature review and bibliometric analysis. Medicine, 96 (6), e4822.



How to Cite

SILVA, S. F. S.; ALBUQUERQUE, C. A. N. de; ALVES, S. L. de Ávila; OLIVEIRA, H. A. de; LIMA, R. C. de M.; MANRIQUE, E. J. C. Tuberculous meningitis: performance assessment of Xpert MTB/RIF Ultra for diagnosis. Research, Society and Development, [S. l.], v. 11, n. 3, p. e50211326889, 2022. DOI: 10.33448/rsd-v11i3.26889. Disponível em: Acesso em: 17 jun. 2024.



Health Sciences