ABSTRACT
We 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-γ release assay (Quantiferon TB gold in tube) 90.2%, automated culture systems (ACS) 81.8%, Löwenstein 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 (κ = -0.189); ACS and L-J culture (κ = -0.172) (p <0.05 for both). Fair and inverse agreement was detected for CSF-ADA and CSF-PCR (κ = -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.
Subject(s)
Adenosine Deaminase/cerebrospinal fluid , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Meningeal/cerebrospinal fluid , Tuberculosis, Meningeal/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Bacteriological Techniques/methods , Early Diagnosis , Female , Humans , Interferon-gamma Release Tests/methods , Male , Middle Aged , Precision Medicine , Retrospective Studies , Tuberculosis, Meningeal/microbiology , Young AdultABSTRACT
Three probable cases of cutaneous anthrax were reported in June 2011 in the eastern part of the Autonomous Province of Vojvodina, Serbia. All cases were involved in slaughtering of a heifer that died and was suspected to have had anthrax. In the same village, anthrax was confirmed in other animals.
Subject(s)
Anthrax/veterinary , Skin Diseases, Bacterial/epidemiology , Abattoirs , Animals , Anthrax/diagnosis , Anthrax/drug therapy , Anthrax/epidemiology , Anthrax/transmission , Anti-Bacterial Agents/therapeutic use , Bacillus anthracis/isolation & purification , Cattle , Cattle Diseases/microbiology , Contact Tracing , Humans , Meat/microbiology , Probability , Serbia/epidemiology , Skin Diseases, Bacterial/diagnosis , Skin Diseases, Bacterial/drug therapy , Treatment OutcomeABSTRACT
Since June 2010, incidence of aseptic meningitis has increased in Novi Sad, Autonomous Province of Vojvodina, Serbia. From 2 June to 25 July 2010, 80 cases of aseptic meningitis were notified, with an incidence rate ranging from 10 to 366 per 100,000 population in different local communities. The majority of cases (n=64) were aged between two and 15 years. Echovirus 30 was cultured from two of four cerebrospinal fluid specimens. The outbreak, for which no common source has yet been identified, is ongoing.
