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Reliability of Diagnostic Criteria for Neurocysticercosis for Patients with Ventricular Cystic Lesions or Granulomas: A systematic review.

ABSTRACT: Intraventricular neurocysticercosis (NCC) is a severe form of NCC requiring prompt diagnosis and treatment. We aimed to assess the reliability of the most recent version of diagnostic criteria for this form of NCC. Two systematic literature reviews were performed; one included case reports of patients with intraventricular cysticercosis and the other included case reports of patients with intraventricular cystic lesions or granulomas caused by infections other than NCC. All assessed cases were categorized according to the last revision of the long-standing Del Brutto's set of diagnostic criteria to determine its sensitivity, specificity, and predictive value for this form of NCC. The search disclosed 128 patients with intraventricular NCC and 41 with other infections. The set of diagnostic criteria classified as definitive NCC 93 cases with intraventricular NCC (sensitivity 72.7%, 95% CI, 63.9-79.9%), as well as four cases with other infections (specificity 90.2%, 95% CI, 75.9-96.8%). The positive and negative predictive values of the criteria were 0.96 (95% CI, 0.89-0.99) and 0.51 (95% CI, 0.39-0.63), respectively. The revised Del Brutto's set of diagnostic criteria for NCC is acceptably sensitive and highly specific for diagnosing patients with the ventricular form of the disease.

SUBMITTER: Bustos JA

PROVIDER: S-EPMC5590602 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Reliability of Diagnostic Criteria for Neurocysticercosis for Patients with Ventricular Cystic Lesions or Granulomas: A systematic review.

Bustos Javier A JA García Hector H HH Del Brutto Oscar H OH

The American journal of tropical medicine and hygiene 20170818 3

Intraventricular neurocysticercosis (NCC) is a severe form of NCC requiring prompt diagnosis and treatment. We aimed to assess the reliability of the most recent version of diagnostic criteria for this form of NCC. Two systematic literature reviews were performed; one included case reports of patients with intraventricular cysticercosis and the other included case reports of patients with intraventricular cystic lesions or granulomas caused by infections other than NCC. All assessed cases were c ...[more]

PMID: 28820689

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Project description:ImportanceNecrobiotic xanthogranuloma (NXG) is a non-Langerhans cell histiocytosis classically associated with paraproteinemia attributable to plasma-cell dyscrasias or lymphoproliferative disorders. Despite the morbidity of NXG, the literature is limited to case reports and small studies, and diagnostic criteria are lacking.ObjectiveTo evaluate the characteristics of NXG and propose diagnostic criteria.Design, setting, and participantsThis multicenter cross-sectional study was conducted at tertiary academic referral centers and followed by a systematic review and a consensus exercise. The multicenter cohort included patients with NXG diagnosed at the Brigham and Women's and Massachusetts General Hospitals (2000-2018), the University of Iowa Hospitals and Clinics (2000-2018), and the University of Pennsylvania Health System (2008-2018). The systematic review was conducted in 2018 and included patients with NXG identified in the Cochrane, Ovid EMBASE, PubMed, and Web of Science databases. The consensus exercise was conducted by 8 board-certified dermatologists to identify diagnostic criteria.Main outcomes and measuresDemographic factors, comorbidities, clinical features, and treatment response.ResultsOf 235 included patients with NXG (34 from the multicenter cohort and 201 from the systematic review results), the mean (SD) age at presentation was 61.6 (14.2) years; 147 (62.6%) were female. Paraproteinemia was detected in 193 patients (82.1%), most often IgG-? (117 patients [50.0%]). A malignant condition was detected in 59 patients (25.1%), most often multiple myeloma (33 patients [14.0%]). The overall rate of paraproteinemia and/or a malignant condition was 83.8% (197 patients). In the multicenter cohort, evolution of paraproteinemia into multiple myeloma was observed up to 5.7 years (median [range], 2.4 [0.1-5.7] years) after NXG presentation. Cutaneous lesions consisted of papules, plaques, and/or nodules, typically yellow or orange in color (113 of 187 [60.4%]) with a periorbital distribution (130 of 219 [59.3%]). The eye was the leading site of extracutaneous involvement (34 of 235 [14.5%]). In the multicenter cohort, intravenous immunoglobulin had the best treatment response rate (9 of 9 patients [100%]), followed by antimalarial drugs (4 of 5 patients [80%]), intralesional triamcinolone (6 of 8 patients [75%]), surgery (3 of 4 patients [75%]), chemotherapy (8 of 12 patients [67%]), and lenalidomide or thalidomide (5 of 8 patients [63%]). The consensus exercise yielded 2 major criteria, which were (1) clinical and (2) histopathological features consistent with NXG, and 2 minor criteria, consisting of (1) paraproteinemia, plasma-cell dyscrasia, and/or other associated lymphoproliferative disorder and (2) periorbital distribution of cutaneous lesions. In the absence of foreign body, infection, or another identifiable cause, fulfillment of both major and at least 1 minor criterion were proposed to establish the diagnosis of NXG.Conclusions and relevanceNecrobiotic xanthogranuloma is a multisystem disorder associated with paraproteinemia and malignant conditions. The proposed diagnostic criteria may advance clinical research and should be validated.

Project description:IntroductionAbnormalities on CT imaging may contribute to the diagnosis of tuberculous meningitis (TBM). Recently, an expert consensus case definition (CCD) and set of imaging criteria for diagnosing basal meningeal enhancement (BME) have been proposed. This study aimed to evaluate the sensitivity, specificity and reliability of these in a prospective cohort of adult meningitis patients.MethodsInitial diagnoses were based on the CCD, classifying patients into: 'Definite TBM' (microbiological confirmation), 'Probable TBM' (diagnostic score ?10), 'Possible TBM' (diagnostic score 6-9), 'Not TBM' (confirmation of an alternative diagnosis) or 'Uncertain' (diagnostic score of <6). CT images were evaluated independently on two occasions by four experienced reviewers. Intra-rater and inter-rater agreement were calculated using the kappa statistic. Sensitivities and specificities were calculated using both 'Definite TBM' and either 'Definite TBM' or 'Probable TBM' as gold standards.ResultsCT scan criteria for BME had good intra-rater agreement (? range 0.35-0.78) and fair to moderate inter-rater agreement (? range 0.20-0.52). Intra- and inter-rater agreement on the CCD components were good to fair (? ?=? ranges 0.47-0.81 and 0.21-0.63). Using 'Definite TBM' as a gold standard, the criteria for BME were very specific (61.5%-100%), but insensitive (5.9%-29.4%). Similarly, the imaging components of the CCD were highly specific (69.2-100%) but lacked sensitivity (0-56.7%). Similar values were found when using 'Definite TBM' or 'Probable TBM' as a gold standard.DiscussionThe fair to moderate inter-rater agreement and poor sensitivities of the criteria for BME suggest that little reliance should be placed in these features in isolation. While the presence of the CCD criteria of acute infarction or tuberculoma(s) appears useful as rule-in criteria, their absence is of little help in excluding TBM. The CCD and criteria for BME, as well as any new criteria, need to be standardized and validated in prospective cohort studies.

Dataset Information

Reliability of Diagnostic Criteria for Neurocysticercosis for Patients with Ventricular Cystic Lesions or Granulomas: A systematic review.

Publications

Reliability of Diagnostic Criteria for Neurocysticercosis for Patients with Ventricular Cystic Lesions or Granulomas: A systematic review.

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