Erdem, H.Ozturk-Engin, D.Elaldi, N.Gulsun, S.Sengoz, G.Crisan, A.Johansen, I. S.Inan, A.Nechifor, M.Al-Mahdawi, A.Civljak, R.Ozguler, M.Savic, B.Ceran, N.Cacopardo, B.Inal, A. S.Namiduru, M.Dayan, S.Kayabas, U.Parlak, E.Khalifa, A.Kursun, E.Sipahi, O. R.Yemisen, M.Akbulut, A.Bitirgen, M.Dulovic, O.Kandemir, B.Luca, C.Parlak, M.Stahl, J. P.Pehlivanoglu, F.Simeon, S.Ulu-Kilic, A.Yasar, K.Yilmaz, G.Yilmaz, E.Beovic, B.Catroux, M.Lakatos, B.Sunbul, M.Oncul, O.Alabay, S.Sahin-Horasan, E.Kose, S.Shehata, G.Andre, K.Alp, A.Cosic, G.Gul, H. CemKarakas, A.Chadapaud, S.Hansmann, Y.Harxhi, A.Kirova, V.Masse-Chabredier, I.Oncu, S.Sener, A.Tekin, R.Deveci, O.Karabay, O.Agalar, C.2019-10-272019-10-2720141198-743X1469-0691https://doi.org/10.1111/1469-0691.12478https://hdl.handle.net/11454/49659We aimed to provide data on the diagnosis of tuberculous meningitis (TBM) in this largest case series ever reported. The Haydarpasa-1 study involved patients with microbiologically confirmed TBM in Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria and Turkey between 2000 and 2012. A positive culture, PCR or Ehrlich-Ziehl-Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) was mandatory for inclusion of meningitis patients. A total of 506 TBM patients were included. The sensitivities of the tests were as follows: interferon- release assay (Quantiferon TB gold in tube) 90.2%, automated culture systems (ACS) 81.8%, Lowenstein Jensen medium (L-J) 72.7%, adenosine deaminase (ADA) 29.9% and EZNs 27.3%. CSF-ACS was superior to CSF L-J culture and CSF-PCR (p<0.05 for both). Accordingly, CSF L-J culture was superior to CSF-PCR (p<0.05). Combination of L-J and ACS was superior to using these tests alone (p<0.05). There were poor and inverse agreements between EZNs and L-J culture (=-0.189); ACS and L-J culture (=-0.172) (p<0.05 for both). Fair and inverse agreement was detected for CSF-ADA and CSF-PCR (=-0.299, p<0.05). Diagnostic accuracy of TBM was increased when both ACS and L-J cultures were used together. Non-culture tests contributed to TBM diagnosis to a degree. However, due to the delays in the diagnosis with any of the cultures, combined use of non-culture tests appears to contribute early diagnosis. Hence, the diagnostic approach to TBM should be individualized according to the technical capacities of medical institutions particularly in those with poor resources.en10.1111/1469-0691.12478info:eu-repo/semantics/openAccessculturediagnosismeningitisPCRtuberculosisArticle2010O600O608WOS:00034582590000424849547Q1Q1