The microbiological diagnosis of tuberculous meningitis: results of Haydarpasa-1 study

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- 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

Strongyloidiasis: Really a Zoonosis?

More than 600 million people are estimated to be infected with the nematode Strongyloides stercoralis, which is often overlooked during routine parasitological diagnostics. Some of the young worms mature to infective larvae within the host, enabling this parasite to establish long-lived, self-sustaining infections. While most of these infections are mild, they can self-enhance, resulting in complicated strongyloidisas, which if not treated in time, is normally lethal. While it is undisputed that dogs are susceptible to experimental infection with human-derived S. stercoralis, it has long been debated if Strongyloides sp. naturally found in dogs are human infective S. stercoralis or belong to a different species, S. canis. Based on recent studies, I argue that dogs naturally carry S. stercoralis, in addition to at least one other species, for which we have no indication that it infects people. I argue that for all practical purposes of S. stercoralis treatment and prevention, dogs should be seriously considered as possible sources for human S. stercoralis. However, from a rigorous scientific point of view, we must admit that currently we have no idea about the relative importance of zoonotic transmission compared with human to human transmission