Validation of the Uniform Case Definition Criteria for Differentiating Tuberculous Meningitis, Viral Meningitis, and Bacterial Meningitis in Adults

Kim, Min Chul; Park, Ki-Ho; Lee, Sang‐Ahm; Kim, Sung-Han

doi:10.3947/ic.2019.51.2.188

Cited by 4 publications

(2 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The differential diagnosis of TBM is sometimes difficult to make with other forms of meningitis with clear fluid, such as viral meningitis, fungal meningitis, carcinomatous meningitis, partially treated bacterial meningitis, brain abscesses, brucellosis, neurosyphilis and neurosarcoidosis [18]. Meningitis with Cryptococcus neoformans has the same clinical picture and changes in CSF as TBM, but with a delayed evolution (sometimes 2-6 months) and occurs more frequently in immunocompromised people, such as patients with HIV infection [19].…”

Section: Csf Examinationmentioning

confidence: 99%

Hydrocephalus in Tuberculous Meningitis

Caliman-Sturdza¹,

Cucu²

2023

Frontiers in Hydrocephalus

View full text Add to dashboard Cite

Hydrocephalus is a frequent complication of tuberculous meningitis. We present the incidence of hydrocephalus in patients diagnosed with tuberculosis of the nervous system, the therapeutic possibilities and the evolution of these patients. A consensus definition for tuberculous meningitis (TBM) stratified the cases as definite, probable and possible. In various studies, radiological investigations (CT, MRI) can be normal in the initial stages of the disease in approximately 30% of cases, but they do not exclude the possibility of a TBM. The most common radiological changes found in TBM are communicating hydrocephalus (up to 80% of cases), increased basal contrast (50%), cerebral tuberculomas (30%) and cerebral infarcts (10–40%). MRI has been shown to be more sensitive than a CT scan for diagnosed TBM. Communicating hydrocephalus is among the short-term complications of TBM (approximately 80% of cases), being more frequent than non-communicating ones. In these cases, the need to perform a ventriculo-peritoneal unit must be taken into account. Long-term complications are cognitive impairment, epilepsy, stroke, hydrocephalus, myelitis, damage to the hypothalamus or the pituitary gland manifested by obesity, growth disorders and diabetes insipidus. Sequels may occur frequently in TBM such as dementia, epilepsy, neurological deficits, behavioral disorders, blindness and deafness.

show abstract

Section: Csf Examinationmentioning

confidence: 99%

Hydrocephalus in Tuberculous Meningitis

Caliman-Sturdza¹,

Cucu²

2023

Frontiers in Hydrocephalus

View full text Add to dashboard Cite

show abstract

“…Due to the paucibacillary nature of TB infection in the central nervous system (CNS), culture and nucleic acid detection (e.g., TB PCR) are insensitive diagnostic tools 4 – 7 compared to the TBM Uniform Case Definition (UCD), which was created to standardize research studies 8 . However, the clinical, radiological, and laboratory criteria that comprise the UCD lack specificity 9 . Thus, there is a double-edged problem of patients with delayed or missed diagnoses of TBM due to the inadequate sensitivity of available diagnostic tests as well as patients inappropriately diagnosed and empirically treated for TBM based on nonspecific clinical, laboratory, and radiologic criteria who have other infectious (and non-infectious) causes of meningitis 10 – 12 .…”

Section: Introductionmentioning

confidence: 99%

Integrating central nervous system metagenomics and host response for diagnosis of tuberculosis meningitis and its mimics

et al. 2022

View full text Add to dashboard Cite

The epidemiology of infectious causes of meningitis in sub-Saharan Africa is not well understood, and a common cause of meningitis in this region, Mycobacterium tuberculosis (TB), is notoriously hard to diagnose. Here we show that integrating cerebrospinal fluid (CSF) metagenomic next-generation sequencing (mNGS) with a host gene expression-based machine learning classifier (MLC) enhances diagnostic accuracy for TB meningitis (TBM) and its mimics. 368 HIV-infected Ugandan adults with subacute meningitis were prospectively enrolled. Total RNA and DNA CSF mNGS libraries were sequenced to identify meningitis pathogens. In parallel, a CSF host transcriptomic MLC to distinguish between TBM and other infections was trained and then evaluated in a blinded fashion on an independent dataset. mNGS identifies an array of infectious TBM mimics (and co-infections), including emerging, treatable, and vaccine-preventable pathogens including Wesselsbron virus, Toxoplasma gondii, Streptococcus pneumoniae, Nocardia brasiliensis, measles virus and cytomegalovirus. By leveraging the specificity of mNGS and the sensitivity of an MLC created from CSF host transcriptomes, the combined assay has high sensitivity (88.9%) and specificity (86.7%) for the detection of TBM and its many mimics. Furthermore, we achieve comparable combined assay performance at sequencing depths more amenable to performing diagnostic mNGS in low resource settings.

show abstract

Sociodemographic and Clinical Factors Associated With Clinical Outcome in Neuroinfectious Diseases: A Multicenter Retrospective Cohort Study

Boubour,

Kim,

Torres

et al. 2024

The Neurohospitalist

View full text Add to dashboard Cite

Objective To evaluate sociodemographic and clinical factors associated with clinical outcomes in patients hospitalized with neuroinfectious diseases at three tertiary care centers in New York City. Methods This retrospective cohort study was conducted at three large urban tertiary care centers between January 1, 2010 and December 31, 2017. Poor clinical outcome was defined as length of hospital stay (LOS) ≥2 weeks and/or discharge to a location other than home. Sociodemographic and clinical factors were obtained from electronic medical records and descriptively analyzed. Multivariate logistic regression analysis investigated relationships between sociodemographic and clinical factors, and outcomes. Results Among 205 patients with definitive neuroinfectious diagnoses, older patients were more likely to have a LOS ≥2 weeks (odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.01-1.05) and less likely to be discharged home (OR: 0.96; 95% CI: 0.94-0.98) than younger patients. Patients with an immunocompromised state were more likely to have a LOS ≥2 weeks (OR: 2.80; 95% CI: 1.17-6.69). Additionally, patients admitted to the intensive care unit (ICU) were more likely to have a LOS ≥2 weeks (OR: 4.65; 95% CI: 2.13-10.16) and less likely to be discharged home (OR: 0.14; 95% CI: 0.06-0.34). There were no statistically significant associations between sex, race, ethnicity, English proficiency, substance use, or poverty index, and clinical outcome. Conclusions In this multicenter cohort of hospitalized neuroinfectious diseases, older age, history of immunocompromised state, and admission to the ICU were significantly associated with poor clinical outcome.

show abstract

Validation of the Uniform Case Definition Criteria for Differentiating Tuberculous Meningitis, Viral Meningitis, and Bacterial Meningitis in Adults

Cited by 4 publications

References 8 publications

Hydrocephalus in Tuberculous Meningitis

Hydrocephalus in Tuberculous Meningitis

Integrating central nervous system metagenomics and host response for diagnosis of tuberculosis meningitis and its mimics

Sociodemographic and Clinical Factors Associated With Clinical Outcome in Neuroinfectious Diseases: A Multicenter Retrospective Cohort Study

Contact Info

Product

Resources

About