Abstract
BackgroundTuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis and its early diagnosis is very difficult leading to present with severe disability or die. The current study aimed to assess the accuracy of metagenomic next generation sequencing (mNGS) for TBM, and to identify a new test for the early diagnosis of TBM.MethodsWe searched for articles published in Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data up to June 30, 2020 for studies that assessed the efficacy of mNGS for the diagnosis of TBM. Then, the accuracy between mNGS and a composite reference standard (CRS) in these articles was compared using the meta-analysis approach.ResultsFour independent studies with 342 samples comparing mNGS and a CRS were included in this study. The sensitivity of mNGS for TBM diagnosis ranged from 27% to 84%. The combined sensitivity of mNGS was 61%, and the I2 value was 92%. Moreover, the specificity of mNGS for TBM diagnosis ranged from 96% to 100%. The combined specificity of mNGS was 98%, and the I2 value was 74%. The heterogeneity between studies in terms of sensitivity and specificity was significant. The area under the curve (AUC) of the summary receiver operating characteristic curve (SROC) of mNGS for TBM was 0.98.ConclusionsThe sensitivity of mNGS for TBM diagnosis was moderate. Furthermore, the specificity was extremely high, and the AUC of the SROC indicated a very good diagnostic efficacy. mNGS could be used as an early diagnostic method for TBM, however, the results should be treated with caution for the heterogeneity between studies was extremely significant.Systematic review registrationINPLASY202070100.
Highlights
Tuberculosis (TB) is a serious threat to human health worldwide [1]
We searched for articles published in Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data up to June 30, 2020 for studies that assessed the efficacy of metagenomic next generation sequencing (mNGS) for the diagnosis of Tuberculous meningitis (TBM)
Four independent studies with 342 samples comparing mNGS and a composite reference standard (CRS) were included in this study
Summary
Tuberculosis (TB) is a serious threat to human health worldwide [1]. A high proportion of individuals are infected with tuberculosis annually, and some die from related diseases. In 2018, there were about 10 million new cases of TB worldwide and about 1.45 million deaths from TB [2] This condition is the leading cause of death from infectious diseases [2]. Tuberculous meningitis (TBM) is a highly lethal type of EPTB. It accounts for a relatively small proportion (1%–5%) of new TB cases, 50% of individuals with TBM can die or present with severe disability [4]. Mycobacterium culture in the CSF and AFB smear have extremely low sensitivity, and these methods are time-consuming. Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis and its early diagnosis is very difficult leading to present with severe disability or die. The current study aimed to assess the accuracy of metagenomic generation sequencing (mNGS) for TBM, and to identify a new test for the early diagnosis of TBM
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