Juan Sebastián Saavedra1, Sebastián Urrego1, María Eugenia Toro1, Carlos Santiago Uribe1, Jenny García2, Olga Hernández3, Juan Carlos Arango4, Ángela Beatriz Pérez5, Andrés Franco6, Isabel Cristina Vélez1, Helena Del Corral7. 1. Neurology Section, Department of Internal Medicine, Faculty of Medicine, University of Antioquia, Bloque 6, Calle 64 # 51 D - 154, Medellín, Colombia. 2. Clinical Epidemiology Academic Group (GRAEPIC), Faculty of Medicine, University of Antioquia, Carrera 51 D # 62-29, Edificio Manuel Uribe Ángel, tercer piso, Medellín, Colombia. 3. Instituto Neurológico de Colombia, Calle 55 # 46-36, Medellín, Colombia. 4. Department of Pathology, Faculty of Medicine, University of Antioquia, Bloque 13, Calle 64 N°51 D - 154, Medellín, Colombia. 5. IPS Universitaria Clínica León XIII, Calle 69 # 51 C 24, Medellín, Colombia. 6. Hospital Pablo Tobón Uribe, Calle 78B # 69-240, Medellín, Colombia. 7. MICROBA, School of Microbiology, University of Antioquia, Calle 67 # 53-108 Bloque 5, Medellín, Colombia. Electronic address: helena.delcorral@udea.edu.co.
Abstract
OBJECTIVE: To determine the diagnostic accuracy of Thwaites Index (TI) in a Colombian population to distinguish meningeal tuberculosis (MTB) from bacterial meningitis (BM) and from non-tuberculous meningitis. Exploratory analyses were conducted to assess the TI's validity for patients with human immunodeficiency virus (HIV) and children above six-years-old. METHODS: The study included 527 patients, the TI was calculated and results compared with those of a reference standard established by expert neurologists. Sensitivity, specificity, area under the curve of receiver-operator characteristics (AUC-ROC) and likelihood ratios were calculated. RESULTS: The AUC-ROC to distinguish MTB from non-tuberculous meningitis was 0.72 (95% CI: 0.67-0.77) for HIV negative adults. AUC-ROC was 0.62 (95% CI: 0.50-0.74) for HIV positive adults and 0.83 (95% CI: 0.68-0.97) for children. For distinguishing MTB from BM the AUC-ROC was 0.78 (95% CI: 0.73-0.83); furthermore, the AUC-ROC was 0.57 (95% CI: 0.31-0.83) for HIV positive adults and 0.86 (95% CI: 0.73-0.99) for children. CONCLUSION: The TI was sensitive but not specific when used to distinguish MTB from BM in HIV negative adults. In HIV positive adults the index had low diagnostic accuracy. Moreover, the TI showed discrimination capability for children over 6years; however, research with larger samples is required in these.
OBJECTIVE: To determine the diagnostic accuracy of Thwaites Index (TI) in a Colombian population to distinguish meningeal tuberculosis (MTB) from bacterial meningitis (BM) and from non-tuberculous meningitis. Exploratory analyses were conducted to assess the TI's validity for patients with human immunodeficiency virus (HIV) and children above six-years-old. METHODS: The study included 527 patients, the TI was calculated and results compared with those of a reference standard established by expert neurologists. Sensitivity, specificity, area under the curve of receiver-operator characteristics (AUC-ROC) and likelihood ratios were calculated. RESULTS: The AUC-ROC to distinguish MTB from non-tuberculous meningitis was 0.72 (95% CI: 0.67-0.77) for HIV negative adults. AUC-ROC was 0.62 (95% CI: 0.50-0.74) for HIV positive adults and 0.83 (95% CI: 0.68-0.97) for children. For distinguishing MTB from BM the AUC-ROC was 0.78 (95% CI: 0.73-0.83); furthermore, the AUC-ROC was 0.57 (95% CI: 0.31-0.83) for HIV positive adults and 0.86 (95% CI: 0.73-0.99) for children. CONCLUSION: The TI was sensitive but not specific when used to distinguish MTB from BM in HIV negative adults. In HIV positive adults the index had low diagnostic accuracy. Moreover, the TI showed discrimination capability for children over 6years; however, research with larger samples is required in these.