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Uniform research case definition criteria differentiate tuberculous and bacterial meningitis in children

Regan S Solomons1, Marie Wessels1, Douwe H Visser2

  • 1Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|August 21, 2014
PubMed
Abstract

Insights

The "probable tuberculous meningitis" (TBM) criteria effectively distinguish TBM from bacterial meningitis in children. However, sensitivity may be reduced in early-stage TBM, requiring further research for clinical trial application.

Area of Science:

  • Pediatric infectious diseases
  • Neurology
  • Microbiology

Background:

  • Tuberculous meningitis (TBM) research faces challenges due to limited microbiologically confirmed cases.
  • Existing research case definitions for TBM have not been validated against bacterial meningitis.
  • This study addresses the need for a reliable TBM case definition for research and clinical trials.

Purpose of the Study:

  • To evaluate a uniform TBM research case definition.
  • To assess the definition's ability to differentiate TBM from bacterial meningitis.
  • To determine the optimal criteria for TBM classification in pediatric cases.

Main Methods:

  • Retrospective analysis of pediatric TBM cases (1985-2005) at Tygerberg Children's Hospital.
  • Comparison with culture-confirmed bacterial meningitis cases (2003-2009) from the National Health Laboratory Service.
  • Evaluation of the proposed TBM case definition's performance using sensitivity and specificity.

Main Results:

  • Of 554 TBM cases, 11.9% were 'definite', 73.6% 'probable', and 13.0% 'possible'.
  • 'Probable TBM' criteria showed 86% sensitivity and 100% specificity in identifying culture-confirmed TBM.
  • 'Possible TBM' criteria increased sensitivity to 100% but decreased specificity to 56%.

Conclusions:

  • The 'probable TBM' criteria demonstrate high accuracy in differentiating TBM from bacterial meningitis.
  • These criteria are suitable for consideration in clinical trials for TBM research.
  • A limitation is the reduced sensitivity of 'probable TBM' criteria in early-stage (stage 1) TBM.
Keywords:
case definitiondiagnostic valuetuberculous meningitis

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