comparison of a clinical prediction rule and a lam antigen-detection assay for the rapid diagnosis of tbm in a high hiv prevalence setting比较临床预测规则和林的快速诊断抗原检测试验tbm在高艾滋病毒流行率设置.pdf

Comparison of a Clinical Prediction Rule and a LAM Antigen-Detection Assay for the Rapid Diagnosis of TBM in a High HIV Prevalence Setting 1 2 3 2 4 Vinod B. Patel , Ravesh Singh , Cathy Connolly , Victoria Kasprowicz , Allimudin Zumla , Thumbi Ndungu2, Keertan Dheda4,5,6* 1 Department of Neurology, University of KwaZulu Natal, Berea, South Africa, 2 HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Berea, South Africa, 3 Biostatistics Unit, Medical Research Council, Durban, South Africa, 4 Department of Infection, Centre for Infectious Diseases and International Health, University College London, London, United Kingdom, 5 Lung Infection and Immunity Unit, Division of Pulmonology and Department of Medicine, University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa, 6 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa Abstract Background/Objective: The diagnosis of tuberculous meningitis (TBM) in resource poor TB endemic environments is challenging. The accuracy of current tools for the rapid diagnosis of TBM is suboptimal. We sought to develop a clinical- prediction rule for the diagnosis of TBM in a high HIV prevalence setting, and to compare performance outcomes to conventional diagnostic modalities and a novel lipoarabinomannan (LAM) antigen detection test (Clearview-TBH) using cerebrospinal fluid (CSF). Methods: Patients with suspected TBM were classified as definite-TBM (CSF culture or PCR positive), probable-TBM and non-TBM. Results: Of the 150 patients, 84% were HIV-infected (median [IQR] CD4 count = 132 [54; 241] cells/ml). There