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Diagnostic accuracy of a uniform research case definition for TBM in children: a prospective study

R S Solomons1, D H Visser2, B J Marais3

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

The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease
|June 12, 2016
PubMed

Insights

Diagnosing tuberculous meningitis (TBM) is challenging. A probable TBM score shows high specificity but may miss 26% of pediatric TBM cases, requiring further research before clinical use.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Neurology

Background:

  • Bacteriological confirmation of tuberculous meningitis (TBM) presents significant challenges in guiding clinical management.
  • A standardized TBM case definition has been proposed for research applications.

Purpose of the Study:

  • To evaluate the accuracy of a probable TBM scoring system in differentiating TBM from other meningitis causes in children.
  • To assess the sensitivity and specificity of the TBM score against bacteriologically confirmed cases.

Main Methods:

  • Prospective enrollment of 139 pediatric meningitis patients (3 months to 13 years) at Tygerberg Hospital, Cape Town.
  • Cerebrospinal fluid analysis was used for meningitis confirmation.
  • Comparison of bacteriologically confirmed TBM cases with 'non-TBM' controls to assess the TBM score's accuracy.

Main Results:

  • Of 139 patients, 79 were diagnosed with TBM (35 bacteriologically confirmed).
  • The probable TBM score achieved a sensitivity of 74% and a specificity of 97% compared to bacteriologically confirmed TBM.
  • Nucleic acid amplification tests like GenoType MTBDRplus and Xpert MTB/RIF aided in confirming TBM in culture-negative cases.

Conclusions:

  • The probable TBM score demonstrates high specificity for diagnosing TBM.
  • The current case definition may miss up to 26% of pediatric TBM cases.
  • Further validation of an algorithm-based approach for TBM diagnosis is recommended for clinical practice.
Abstract

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