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Rapid Accurate Identification of Tuberculous Meningitis Among South African Children Using a Novel Clinical Decision
Insights
A new clinical decision tool, CHILD TB LP, aids in the early diagnosis of childhood tuberculous meningitis (TBM). It accurately identifies TBM in children, offering a promising rapid diagnostic solution.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Early diagnosis of tuberculous meningitis (TBM) is critical for optimal patient outcomes.
- Currently, no rapid diagnostic tests are available for childhood TBM.
- This study aimed to develop a clinical decision tool for early TBM diagnosis in children.
Purpose of the Study:
- To develop and validate a clinical decision tool for the early diagnosis of childhood tuberculous meningitis (TBM).
- To identify key clinical variables predictive of TBM in children.
- To create a tool that can be used in resource-limited settings.
Main Methods:
- A retrospective case-control study was conducted across seven hospitals in KwaZulu-Natal, South Africa.
- Variables predictive of microbiologically confirmed TBM were identified using univariate analysis.
- A clinical decision tool, CHILD TB LP, was developed and tested on an independent sample.
Main Results:
- Of 865 children with suspected TBM, 25 (3%) had microbiologically confirmed TBM.
- The CHILD TB LP tool, based on nine predictive variables, achieved 100% sensitivity and 90% specificity.
- The tool accurately classified an independent sample of TBM cases and controls.
Conclusions:
- The CHILD TB LP decision tool demonstrates high accuracy in classifying microbiologically confirmed TBM in children.
- Prospective evaluation of CHILD TB LP is recommended as a novel rapid diagnostic tool.
- This tool could aid in the initial evaluation of children with suspected neurological infections in similar settings.
Background:
Early diagnosis of tuberculous meningitis (TBM) is crucial to achieve optimum outcomes. There is no effective rapid diagnostic test for use in children. We aimed to develop a clinical decision tool to facilitate the early diagnosis of childhood TBM.
Methods:
Retrospective case-control study was performed across 7 hospitals in KwaZulu-Natal, South Africa (2010-2014). We identified the variables most predictive of microbiologically confirmed TBM in children (3 months to 15 years) by univariate analysis. These variables were modelled into a clinical decision tool and performance tested on an independent sample group.
Results:
Of 865 children with suspected TBM, 3% (25) were identified with microbiologically confirmed TBM. Clinical information was retrieved for 22 microbiologically confirmed cases of TBM and compared with 66 controls matched for age, ethnicity, sex and geographical origin. The 9 most predictive variables among the confirmed cases were used to develop a clinical decision tool (CHILD TB LP): altered Consciousness; caregiver HIV infected; Illness length >7 days; Lethargy; focal neurologic Deficit; failure to Thrive; Blood/serum sodium <132 mmol/L; CSF >10 Lymphocytes ×10/L; CSF Protein >0.65 g/L. This tool successfully classified an independent sample of 7 cases and 21 controls with a sensitivity of 100% and specificity of 90%.
Conclusions:
The CHILD TB LP decision tool accurately classified microbiologically confirmed TBM. We propose that CHILD TB LP is prospectively evaluated as a novel rapid diagnostic tool for use in the initial evaluation of children with suspected neurologic infection presenting to hospitals in similar settings.
