Table 4 Diagnostic performance of Xpert MTB/RIF ultra, Xpert MTB/RIF, Lowenstein-Jensen culture, and acid-fast bacilli microscopy compared with uniform clinical case definition, composite microbiological reference standard, and culture for detection of TB meningitis in children.

From: Performance of Xpert MTB/RIF ultra for the diagnosis of tuberculous meningitis in children using cerebrospinal fluid

 

Ultra

% (95% CI); n/N

Xpert

% (95% CI); n/N

L-J Culture

% (95% CI); n/N

AFB microscopy

% (95% CI); n/N

Reference standard: probable and definite TBM (clinical case definition)

 Sensitivity

88.0% (75.7–95.5); 44/50

34.0% (21.2–48.8); 17/50

30.0% (17.9–44.6); 15/50

2.0% (0.05–10.7); 1/50

 Specificity

100% (97.3–100); 137/137

100% (97.3–100); 137/137

100% (97.3–100); 137/137

100% (97.3–100); 137/137

 PPV

100% (92–100)

100% (80.5–100)

100% (78.2–100)

100% (2.5–100)

 NPV

95.8% (91.5–98.0); 137/143

80.6% (77.3–83.5); 137/170

79.7% (76.6–82.4); 137/172

73.7% (72.9–74.4); 137/186

Reference standard: possible, probable, and definite TBM (clinical case definition)

 Sensitivity

35.5% (27.1–44.6); 44/124

13.7% (8.2–21.0); 17/124

12.1% (6.9–19.2); 15/124

0.81% (0.02–4.4); 1/124

 Specificity

100% (94.3–100); 63/63

100% (94.3–100); 63/63

100% (94.3–100); 63/63

100% (94.3–100); 63/63

 PPV

100% (92–100)

100% (80.5–100)

100% (78.2–100)

100% (2.5–100)

 NPV

44.1% (40.9–47.3); 63/143

37.1% (35.4–38.7); 63/170

36.6% (35.1–38.2); 63/172

33.9 (33.5–34.2)

Reference standard: composite microbiological reference standard

 Sensitivity

100% (92.0-100); 44/44

38.6% (24.4–54.5); 17/44

34.1% (20.5–49.9); 15/44

2.3% (0.06-12.0); 1/44

 Specificity

100% (97.5–100); 143/143

100% (97.5–100); 143/143

100% (97.5–100); 143/143

100% (97.5–100); 143/143

 PPV

100% (92–100)

100% (80.5–100)

100% (78.2–100)

100% (2.5–100)

 NPV

100% (97.5–100); 143/143

84.1% (80.7–87.0); 143/170

83.1% (80.0-85.9); 143/172

76.9% (76.1–77.7); 143/186

Reference standard: culture

 Sensitivity

100% (78.2–100); 15/15

93.3% (68.1–99.8); 14/15

-

6.7% (0.2–32.0); 1/15

 Specificity

83.1% (76.7–88.4); 143/172

98.3% (95.0-99.6); 169/172

-

100.0% (97.9–100); 172/172

 PPV

34.1 (27.1–41.9); 15/44

82.4 (60.1–93.5); 14/17

-

100 (2.5–100); 1/1

 NPV

100% (97.5–100); 143/143

99.4 (96.2–99.9); 169/170

-

92.5 (91.5–93.4); 172/186

  1. Xpert, Xpert MTB/RIF; Ultra, Xpert MTB/RIF Ultra; L-J, Lowenstein-Jensen; AFB, acid-fast bacilli; TBM, tuberculous meningitis; PPV, positive predictive value; NPV, negative predictive value.
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