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.

Basu Roy, Robindra and Thee, Stephanie and Blázquez-Gamero, Daniel and Falcón-Neyra, Lola and Neth, Olaf and Noguera-Julian, Antoni and Lillo, Cristina and Galli, Luisa and Venturini, Elisabetta and Buonsenso, Danilo and Götzinger, Florian and Martinez-Alier, Nuria and Velizarova, Svetlana and Brinkmann, Folke and Welch, Steven B and Tsolia, Maria and Santiago-Garcia, Begoña and Krüger, Renate and Tebruegge, Marc (2020) 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. The European respiratory journal. ISSN 1399-3003.

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Official URL: https://erj.ersjournals.com/content/early/2020/03/...

Abstract

INTRODUCTION

Tuberculous meningitis (TBM) is often diagnostically challenging. Only limited data exist on the performance of interferon-gamma release assays (IGRA) and molecular assays in children with TBM in routine clinical practice, particularly in the European setting.

METHODS

Multicenter, 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 ≥1 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%); 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%), and CSF polymerase-chain-reaction (PCR) in 34.8% (95%CI: 22.9-43.7%). In the subgroup of children who had TST, IGRA, CSF culture and CSF PCR performed 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.

Item Type: Article
Subjects: QW Microbiology. Immunology
WF Respiratory system. Respiratory medicine
Divisions: Planned IP Care > Respiratory Medicine
Womens and Childrens > Paediatrics
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Depositing User: Mr Philip O'Reilly
Date Deposited: 30 Apr 2020 14:07
Last Modified: 30 Apr 2020 14:07
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3022

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