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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 Tuberculosi Infants Meningitis Tuberculosis Children |
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. |
Note: | Reproducció del document publicat a: https://doi.org/10.1183/13993003.02004-2019 |
It is part of: | European Respiratory Journal, 2020, vol. 56, p. 1902004 |
URI: | http://hdl.handle.net/2445/173184 |
Related resource: | https://doi.org/10.1183/13993003.02004-2019 |
ISSN: | 0903-1936 |
Appears in Collections: | Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques) |
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