Rapid Accurate Identification of Tuberculous Meningitis Among South African Children Using a Novel Clinical Decision Tool

Anu Goenka, Prakash M Jeena, Koleka Mlisana, Tom Solomon, Kevin Spicer, Rebecca Stephenson, Arpana Verma, Barnesh Dhada, Michael J Griffiths

Research output: Contribution to journalArticle (Academic Journal)

Abstract

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.

Original languageEnglish
Pages (from-to)229-234
Number of pages6
JournalPediatric Infectious Disease Journal
Volume37
Issue number3
DOIs
Publication statusPublished - Mar 2018

Keywords

  • Adolescent
  • Age Factors
  • Antitubercular Agents/administration & dosage
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Clinical Decision-Making
  • Diagnostic Tests, Routine/methods
  • Disease Management
  • Drug Therapy, Combination
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Population Surveillance
  • Retrospective Studies
  • South Africa/epidemiology
  • Tuberculosis, Meningeal/diagnosis

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