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Title: Performance of immune-based and microbiological tests in children with TB meningitis in Europe - a multi-center Paediatric Tuberculosis Network European Trials Group (ptbnet) study
Author: Basu Roy, Robindra
Thee, Stephanie
Blázquez Gamero, Daniel
Falcón Neyra, Lola
Neth, Olaf
Noguera Julian, Antoni
Lillo, Cristina
Galli, Luisa
Venturini, Elisabetta
Buonsenso, Danilo
Götzinger, Florian
Martinez Alier, Nuria
Velizarova, Svetlana
Brinkmann, Folke
Welch ,Steven B.
Tsolia, Maria
Santiago Garcia, Begoña
Krüger, Renate
Tebruegge, Marc
ptbnet TB Meningitis Study Group
Keywords: Meningitis
Issue Date: 16-Apr-2020
Publisher: European Respiratory Society
Abstract: Introduction: Tuberculous meningitis (TBM) is often diagnostically challenging. Only limited data exist on the performance of interferon-γ release assays (IGRA) and molecular assays in children with TBM in routine clinical practice, particularly in the European setting. Methods: Multicentre, retrospective study involving 27 healthcare institutions providing care for children with tuberculosis (TB) in nine European countries. Results: Of 118 children included, 54 (45.8%) had definite, 38 (32.2%) probable and 26 (22.0%) possible TBM; 39 (33.1%) had TBM grade 1, 68 (57.6%) grade 2 and 11 (9.3%) grade 3. Of 108 patients who underwent cranial imaging 90 (83.3%) had at least one abnormal finding consistent with TBM. At the 5-mm cut-off the tuberculin skin test had a sensitivity of 61.9% (95% CI 51.2-71.6%) and at the 10-mm cut-off 50.0% (95% CI 40.0-60.0%). The test sensitivities of QuantiFERON-TB and T-SPOT.TB assays were 71.7% (95% CI 58.4-82.1%) and 82.5% (95% CI 58.2-94.6%), respectively (p=0.53). Indeterminate results were common, occurring in 17.0% of QuantiFERON-TB assays performed. Cerebrospinal fluid (CSF) cultures were positive in 50.0% (95% CI 40.1-59.9%) of cases, and CSF PCR in 34.8% (95% CI 22.9-43.7%). In the subgroup of children who underwent tuberculin skin test, IGRA, CSF culture and CSF PCR simultaneously, 84.4% had at least one positive test result (95% CI 67.8%-93.6%). Conclusions: Existing immunological and microbiological TB tests have suboptimal sensitivity in children with TBM, with each test producing false-negative results in a substantial proportion of patients. Combining immune-based tests with CSF culture and CSF PCR results in considerably higher positive diagnostic yields, and should therefore be standard clinical practice in high-resource settings.
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It is part of: European Respiratory Journal, 2020, vol. 56, p. 1902004
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ISSN: 0903-1936
Appears in Collections:Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)

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