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We disagree with the recommendation by the World Health Organization to use Xpert(®) MTB/RIF on cerebrospinal fluid for the initial diagnosis of tuberculous meningitis (TBM). TBM is a devastating disease requiring empirical treatment even when the probability of disease is low. We suggest that a useful TBM diagnostic test needs a negative predictive value (NPV) of ⩾ 99% so that empirical treatment can be stopped safely. The NPV of Xpert is around 84%, making a negative test of limited value. While better tests are awaited, a composite score, possibly combining Xpert with clinical variables and with high NPV, should be constructed and validated prospectively.

Original publication




Journal article


Int J Tuberc Lung Dis

Publication Date





276 - 277


Antibiotics, Antitubercular, Cerebrospinal Fluid, Humans, Molecular Diagnostic Techniques, Mycobacterium tuberculosis, Nucleic Acid Amplification Techniques, Predictive Value of Tests, Sensitivity and Specificity, Specimen Handling, Tuberculosis, Meningeal