Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in HIV-infected adults: a prospective cohort study Nathan C Bahr, MD, Edwin Nuwagira,

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Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in HIV-infected adults: a prospective cohort study Nathan C Bahr, MD, Edwin Nuwagira, MBChB, Emily E Evans, BS, Fiona V Cresswell, MBChB, Philip V Bystrom, BA, Adolf Byamukama, BMLS, Sarah C Bridge, BS, Ananta S Bangdiwala, MS, David B Meya, PhD, Claudia M Denkinger, MD, Conrad Muzoora, MMed, Prof David R Boulware, MD Darlisha A Williams, Kabanda Taseera, Dan Nyehangane, Mugisha Ivan, Patrick Orikiriza, Joshua Rhein, Kathy Huppler Hullsiek, Abdu Musubire, Katelyn Pastick, Pamela Nabeta, James Mwesigye, Radha Rajasingham Nathan C Bahr, MD, Edwin Nuwagira, MBChB, Emily E Evans, BS, Fiona V Cresswell, MBChB, Philip V Bystrom, BA, Adolf Byamukama, BMLS, Sarah C Bridge, BS, Ananta S Bangdiwala, MS, David B Meya, PhD, Claudia M Denkinger, MD, Conrad Muzoora, MMed, Prof David R Boulware, MD Darlisha A Williams, Kabanda Taseera, Dan Nyehangane, Mugisha Ivan, Patrick Orikiriza, Joshua Rhein, Kathy Huppler Hullsiek, Abdu Musubire, Katelyn Pastick, Pamela Nabeta, James Mwesigye, Radha Rajasingham The Lancet Infectious Diseases Volume 18, Issue 1, Pages 68-75 (January 2018) DOI: 10.1016/S1473-3099(17)30474-7 Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 1 Trial profile Composite reference standard was culture, Xpert, or Xpert Ultra. CSF=cerebrospinal fluid. Xpert=Xpert MTB/RIF. *Suspected meningitis with normal cerebrospinal fluid profile of <5 leucocytes per μL and protein <40 mg/dL. The Lancet Infectious Diseases 2018 18, 68-75DOI: (10.1016/S1473-3099(17)30474-7) Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 2 Venn diagram of overlap in tuberculous meningitis diagnostics The Venn diagram displays 22 participants with tuberculosis detected in CSF by each diagnostic test and the overlap between tests. Of eight participants positive by Xpert Ultra only, six had recently initiated HIV therapy, and all eight were negative by testing with cryptococcal antigen, India ink, Gram stain, culture, and multiplex PCR for 14 common meningitis pathogens. Xpert=Xpert MTB/RIF. MGIT=mycobacteria growth indicator tube. CSF=cerebrospinal fluid. The Lancet Infectious Diseases 2018 18, 68-75DOI: (10.1016/S1473-3099(17)30474-7) Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions