Diagnosing Cryptococcal and Tuberculous Meningitis

Given the high prevalence of cryptococcus and the similar initial presentations between cryptococcal meningitis and tuberculous meningitis, fingerstick cryptococcal antigen lateral flow assay (LFA; Immy, Norman, OK, USA) was done at the participant's bedside. Thereafter, lumbar puncture was done for all participants, CSF opening pressure was recorded, and CSF was collected into a sterile tube with a target volume of more than 6 mL. At the bedside, CSF glucose and lactate were measured from a drop of CSF collected into an Eppendorf tube using a handheld OneTouch glucose meter (OneTouch; Lifescan, Inverness, UK) and a point-of-care lactate meter (Nova Biomedical; Waltham, MA, USA). Xpert and Xpert Ultra results were returned to the study team within 24 h to guide treatment decisions.
Clinical history, physical examination, and detailed neurological assessment findings were recorded as recommended by the Tuberculous Meningitis International Research Consortium.²² (link) Other diagnostic tests, including urine tuberculosis lipoarabinomannan (Alere Determine; Alere, Waltham, MA, USA), chest radiograph, abdominal ultrasonography, brain imaging, and sputum Xpert, were done as clinically indicated and when locally available.