Rapid clinical score for the diagnosis of tuberculous meningitis: A retrospective cohort study

Abstract

Objective:The aim of our study was to retrospectively validate a previously described rapid clinical score (RCS) in distinguishing tuberculous meningitis (TBM) from viral meningitis (VM) in people who are at increased risk of tuberculosis, as well as from cryptococcal meningitis (CM) in HIV-infected patients.Methods:We performed a retrospective study of patients admitted with a diagnosis of aseptic meningitis between January 2012 and December 2015, to a referral hospital for infectious diseases. The variables included in RCS were duration of symptoms before admission, neurological stage, cerebrospinal fluid (CSF) to blood glucose ratio, and CSF protein. We included in this retrospective study 31 patients with definite or probable TBM including 14 HIV-infected patients, 62 HIV-noninfected patients with VM, and 18 HIV-infected patients with CM.Results:The sensitivity of RCS to distinguish TBM from VM was 96.7%, with a specificity of 81.1% and the area under the receiver operating characteristic (ROC) curve was 0.949 (0.90–0.99). When all four criteria from the RCS were present, the specificity increased at 100%. In HIV-infected patients, the sensitivity and specificity of RCS in differentiating TBM from CM were 86.6% and 27.7%, respectively, and the area under the ROC curve was 0.669 (0.48–0.85).Conclusion:This easy-to-use RCS was found to be helpful in differentiating TBM from VM, with a better sensitivity than molecular amplification techniques and a relatively good specificity. However, the RCS was not useful to differentiate between TBM and CM in HIV-infected patients.

A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis

“…However, a differential diagnosis between TBM and VM is more difficult because both may have very similar CSF findings. 13 14 If it is difficult on initial CSF tests to distinguish TBM from other forms of meningitis, many physicians tend to initiate empiric anti-tuberculosis treatments as soon as TBM is considered by clinical suspicion.…”

“…5 11 On the other hand, viral meningitis (VM) and TBM may show similar clinical courses and CSF findings in some clinical situations. 13 14 …”

“…A case-control study conducted to evaluate the risk factors of TBM in a comparison of TBM and VM suggested four factors, namely, duration of illness, neurological stage, CSF/blood glucose ratio, and CSF protein. 13 14 Some studies on TBM have emphasized that hyponatremia and cranial nerve palsy are frequently associated with poor outcomes. A case-control study of hyponatremia in TBM showed that patients with hyponatremia had poor prognosis with lower Glasgow Coma Scale (GCS) scores (odds ratio [OR], 1.2; P = 0.03) and basal exudate (OR, 6.5; P = 0.001).…”

Autoimmune glial fibrillary acidic protein astrocytosis mimicking tuberculous meningitis: a retrospective study

“…The sensitivity using a CSF to serum glucose ratio of < 0.5 was 90%. In a study by Jipa et al [ 20 ], 90.3% of their TBM patients had CSF/blood glucose ratios < 0.5. Since CSF glucose concentration is highly dependent on blood glucose concentration, the CSF/ blood glucose ratio is more significant in the differential diagnosis to exclude blood factors.…”