Diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis: a systematic review and meta-analysis - 28/08/11

Doi : 10.1016/S1473-3099(03)00772-2

Madhukar Pai ^a,^b, Laura L Flores ^a,^c, Nitika Pai ^a,^b, Alan Hubbard, Prof ^a,^d, Lee W Riley ^a,^e, John M Colford, Prof, Dr ^a,^f,^⁎
^a University of California, Berkeley, CA, USA
^b Division of Epidemiology
^c Division of Infectious Diseases, and is also affiliated with Departamento de Biomedicina Molecular CINVESTAV-IPN, Mexico
^d Adjunct Assistant Professor of Biostatistics
^e Infectious Diseases
^f Associate Professor of Epidemiology

^*Correspondence: Dr John M Colford, Division of Epidemiology, School of Public Health, University of California, Berkeley, 140 Warren Hall, Berkeley CA 94720, USA. Tel +1 510 643 1076; fax 413 228 5931

Summary

Conventional tests are not always helpful in making a diagnosis of tuberculous meningitis. We did a systematic review and meta-analysis to establish the summary accuracy of nucleic acid amplification (NAA) tests for tuberculous meningitis. We searched six electronic databases and contacted authors, experts, and manufacturers. Measures of diagnostic accuracy were pooled using a random effects model. 49 studies met our inclusion criteria. The summary estimates in 14 studies with commercial NAA tests were: sensitivity 0·56 (95% CI 0·46, 0·66), specificity 0·98 (0·97, 0·99), positive likelihood ratio 35·1 (19·0, 64·6), negative likelihood ratio 0·44 (0·33, 0·60), and diagnostic odds ratio 96·4 (42·8, 217·3). In the 35 studies with in-house (“homebrew”) tests, the summary accuracy could not be established with confidence because of wide variability in test accuracy. On current evidence, commercial NAA tests show a potential role in confirming tuberculous meningitis diagnosis, although their overall low sensitivity precludes the use of these tests to rule out tuberculous meningitis with certainty.

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