Τίτλος:
Performance of immune-based and microbiological tests in children with tuberculosis meningitis in Europe: A multicentre paediatric tuberculosis network european trials group (ptbnet) study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Introduction: Tuberculous meningitis (TBM) is often diagnostically challenging. Only limited data exist on the performance of interferon-ã 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. Copyright © 2020 ERS.
Συγγραφείς:
Roy, R.B.
Thee, S.
Blázquez-Gamero, D.
Falcón-Neyra, L.
Neth, O.
Noguera-Julian, A.
Lillo, C.
Galli, L.
Venturini, E.
Buonsenso, D.
Götzinger, F.
Martinez-Alier, N.
Velizarova, S.
Brinkmann, F.
Welch, S.B.
Tsolia, M.
Santiago-Garcia, B.
Krüger, R.
Tebruegge, M.
Περιοδικό:
European Respiratory Journal
Εκδότης:
European Respiratory Society
Λέξεις-κλειδιά:
acid fast bacterium; adolescent; altered state of consciousness; Article; bacterium culture; bacterium detection; cerebrospinal fluid culture; child; clinical feature; computer assisted tomography; controlled study; diagnostic value; echography; Europe; false negative result; female; fever; granuloma; groups by age; headache; hepatomegaly; human; hydrocephalus; immunological procedures; infant; interferon gamma release assay; intraabdominal granulomas; intracranial tuberculoma; major clinical study; male; microbiological examination; multicenter study (topic); Mycobacterium tuberculosis; neuroimaging; nonhuman; nuclear magnetic resonance imaging; polymerase chain reaction; preschool child; priority journal; retrospective study; sensitivity analysis; splenomegaly; tuberculin test; tuberculous meningitis; vomiting
DOI:
10.1183/13993003.02004-2019
