RT Journal Article
T1 Performance of immune-based and microbiological tests in children with tuberculosis meningitis in Europe: a multicentre Paediatric Tuberculosis Network European Trials Group (ptbnet) study.
A1 Basu Roy, Robindra
A1 Thee, Stephanie
A1 Blázquez-Gamero, Daniel
A1 Falcón-Neyra, Lola
A1 Neth, Olaf
A1 Noguera-Julian, Antoni
A1 Lillo, Cristina
A1 Galli, Luisa
A1 Venturini, Elisabetta
A1 Buonsenso, Danilo
A1 Götzinger, Florian
A1 Martinez-Alier, Nuria
A1 Velizarova, Svetlana
A1 Brinkmann, Folke
A1 Welch, Steven B
A1 Tsolia, Maria
A1 Santiago-Garcia, Begoña
A1 Krüger, Renate
A1 Tebruegge, Marc
A1 ptbnet TB Meningitis Study Group, 
AB Tuberculous meningitis (TBM) is often diagnostically challenging. Only limited data exist on the performance of interferon-γ release assays (IGRA) and molecular assays in children with TBM in routine clinical practice, particularly in the European setting. Multicentre, retrospective study involving 27 healthcare institutions providing care for children with tuberculosis (TB) in nine European countries. 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%). 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.
YR 2020
FD 2020-07-02
LK http://hdl.handle.net/10668/15383
UL http://hdl.handle.net/10668/15383
LA en
DS RISalud
RD Apr 16, 2025