Acute Versus Subacute Community-Acquired Meningitis: Analysis of 611 Adult Patients

Sulaiman, Tarek; Salazar, Lucrecia; Hasbun, Rodrigo

doi:10.1093/ofid/ofw172.878

Cited by 8 publications

(18 citation statements)

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“…Given the subacute history and the monocyte‐predominant CSF with WBC < 100 cells/μl, bacterial meningitis secondary to typical pathogens, although possible, was less likely . Subacute causes of meningitis commonly occur in the setting of viral, parasitic, fungal, or atypical bacterial infections, such as TB . Multiple investigations for these types of pathogens were negative, and there was no evidence of systemic infection by CT or FDG‐PET CT.…”

Section: Differential Diagnosis Discussionmentioning

confidence: 99%

“…2 Multiple investigations for these types of pathogens were negative, and there was no evidence of systemic infection by CT or FDG-PET CT. An infectious cause was appropriately at the top of the differential.…”

Section: Infectiousmentioning

confidence: 96%

“…1,2 Subacute causes of meningitis commonly occur in the setting of viral, parasitic, fungal, or atypical bacterial infections, such as TB. 2 Multiple investigations for these types of pathogens were negative, and there was no evidence of systemic infection by CT or FDG-PET CT. However, TB PCR and culture are insensitive, and up to half of people with TBM have no evidence of systemic disease.…”

Section: Infectiousmentioning

confidence: 99%

See 2 more Smart Citations

Clinicopathology conference: 41‐year‐old woman with chronic relapsing meningitis

Beck

Ramachandran

Khan

et al. 2019

Annals of Neurology

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Section: Differential Diagnosis Discussionmentioning

confidence: 99%

Section: Infectiousmentioning

confidence: 96%

Section: Infectiousmentioning

confidence: 99%

See 1 more Smart Citation

Clinicopathology conference: 41‐year‐old woman with chronic relapsing meningitis

Beck

Ramachandran

Khan

et al. 2019

Annals of Neurology

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“…Meningitis can be categorized as acute and subacute based on duration of symptoms [1]. Subacute meningitis (SAM) is commonly defined as inflammation evolving for greater than 5 days and less than 30 days and chronic meningitis (CM) as greater than 30 days without resolution of cerebrospinal fluid (CSF) abnormalities [1].…”

Section: Introductionmentioning

confidence: 99%

The diagnostic utility of the “Thwaites’ system” and “lancet consensus scoring system” in tuberculous vs. non-tuberculous subacute and chronic meningitis: multicenter analysis of 395 adult patients

et al. 2020

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Background Tuberculous meningitis (TBM) represents a diagnostic and management challenge to clinicians. The “Thwaites’ system” and “Lancet consensus scoring system” are utilized to differentiate TBM from bacterial meningitis but their utility in subacute and chronic meningitis where TBM is an important consideration is unknown. Methods A multicenter retrospective study of adults with subacute and chronic meningitis, defined by symptoms greater than 5 days and less than 30 days for subacute meningitis (SAM) and greater than 30 days for chronic meningitis (CM). The “Thwaites’ system” and “Lancet consensus scoring system” scores and the diagnostic accuracy by sensitivity, specificity, and area under the curve of receiver operating curve (AUC-ROC) were calculated. The “Thwaites’ system” and “Lancet consensus scoring system” suggest a high probability of TBM with scores ≤4, and with scores of ≥12, respectively. Results A total of 395 patients were identified; 313 (79.2%) had subacute and 82 (20.8%) with chronic meningitis. Patients with chronic meningitis were more likely caused by tuberculosis and had higher rates of HIV infection (P < 0.001). A total of 162 patients with TBM and 233 patients with non-TBM had unknown (140, 60.1%), fungal (41, 17.6%), viral (29, 12.4%), miscellaneous (16, 6.7%), and bacterial (7, 3.0%) etiologies. TMB patients were older and presented with lower Glasgow coma scores, lower CSF glucose and higher CSF protein (P < 0.001). Both criteria were able to distinguish TBM from bacterial meningitis; only the Lancet score was able to differentiate TBM from fungal, viral, and unknown etiologies even though significant overlap occurred between the etiologies (P < .001). Both criteria showed poor diagnostic accuracy to distinguish TBM from non-TBM etiologies (AUC-ROC was <. 5), but Lancet consensus scoring system was fair in diagnosing TBM (AUC-ROC was .738), sensitivity of 50%, and specificity of 89.3%. Conclusion Both criteria can be helpful in distinguishing TBM from bacterial meningitis, but only the Lancet consensus scoring system can help differentiate TBM from meningitis caused by fungal, viral and unknown etiologies even though significant overlap occurs and the overall diagnostic accuracy of both criteria were either poor or fair.

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“…In contrast, chronic meningitis can result from infection with Mycobacterium tuberculosis and fungal pathogens including, Aspergillus, Histoplasma, Blastomyces, and Coccidiodes. 17 The inclusion of additional, uncultivable pathogens, may add further value to the panel (eg, Bartonella spp. and Treponema pallidum).…”

Section: Acute Versus Chronic Central Nervous System Infectionsmentioning

confidence: 99%

Direct-from-Specimen Pathogen Identification

Couturier

Bard

2019

Clinics in Laboratory Medicine

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KEYWORDS Syndromic panel Respiratory panel Sepsis panel Gastroenteritis panel Meningitis panel Encephalitis panel KEY POINTSSyndromic panels should evolve to include additional pathogen targets.Syndromic panels should be flexible in design to better meet the user's needs.Syndromic panels should include host response markers to correlate with pathogen detection. Syndromic panels should have shorter run times, less complexity, and be placed near the point of care. Syndromic panels should be expanded to include more antimicrobial resistance determinants and phenotypic susceptibility results.

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Acute Versus Subacute Community-Acquired Meningitis: Analysis of 611 Adult Patients

Cited by 8 publications

References 0 publications

Clinicopathology conference: 41‐year‐old woman with chronic relapsing meningitis

Clinicopathology conference: 41‐year‐old woman with chronic relapsing meningitis

The diagnostic utility of the “Thwaites’ system” and “lancet consensus scoring system” in tuberculous vs. non-tuberculous subacute and chronic meningitis: multicenter analysis of 395 adult patients

Direct-from-Specimen Pathogen Identification

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