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Clin Infect Dis. 2014 Dec 1;59(11):1574-8. doi: 10.1093/cid/ciu665. Epub 2014 Aug 19.

Uniform research case definition criteria differentiate tuberculous and bacterial meningitis in children.

Author information

1
Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
2
Department of Pediatric Infectious Diseases and Immunology, VU University Medical Center, Amsterdam, The Netherlands.
3
Marie Bashir Institute for Infectious Diseases and Biosecurity Institute and The Children's Hospital at Westmead, The University of Sydney, Australia.

Abstract

BACKGROUND:

Tuberculous meningitis (TBM) research is hampered by low numbers of microbiologically confirmed TBM cases and the fact that they may represent a select part of the disease spectrum. A uniform TBM research case definition was developed to address these limitations, but its ability to differentiate TBM from bacterial meningitis has not been evaluated.

METHODS:

We assessed all children treated for TBM from 1985 to 2005 at Tygerberg Children's Hospital, Cape Town, South Africa. For comparative purposes, a group of children with culture-confirmed bacterial meningitis, diagnosed between 2003 and 2009, was identified from the National Health Laboratory Service database. The performance of the proposed case definition was evaluated in culture-confirmed TBM and bacterial meningitis cases.

RESULTS:

Of 554 children treated for TBM, 66 (11.9%) were classified as "definite TBM," 408 (73.6%) as "probable TBM," and 72 (13.0%) as "possible TBM." "Probable TBM" criteria identified culture-confirmed TBM with a sensitivity of 86% and specificity of 100%; sensitivity was increased but specificity reduced when using "possible TBM" criteria (sensitivity 100%, specificity 56%).

CONCLUSIONS:

"Probable TBM" criteria accurately differentiated TBM from bacterial meningitis and could be considered for use in clinical trials; reduced sensitivity in children with early TBM (stage 1 disease) remains a concern.

KEYWORDS:

case definition; diagnostic value; tuberculous meningitis

PMID:
25139968
DOI:
10.1093/cid/ciu665
[Indexed for MEDLINE]

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