Validation of Thwaites Index for diagnosing tuberculous meningitis in a Colombian population

Saavedra, Juan Sebastián; Urrego, Sebastián; Toro, María Eugenia; Uribe, Carlos Santiago; García, Jenny; Hernández, O; Arango, Juan Carlos; Pérez, Ángela; Franco, A.; Vélez, Isabel Cristina Vásquez; Corral, Helena del

doi:10.1016/j.jns.2016.09.007

Cited by 13 publications

(12 citation statements)

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“…3a). Unlike the mentioned studies [12][13][14], our findings of poor sensitivity (1.2%) and high specificity (99.1%) were noticed for Thwaites system in diagnosing TBM (Table 4) because all enrolled patients presented with symptoms more than 5 days, which scores − 5 from the total score, in addition the majority of cases are not due to bacterial meningitis and few had a serum leukocyte count > 15,000 (cells /μL) and/or a CSF Leukocyte count > 900 (cells/μL) (data not shown). Despite the poor diagnostic accuracy, the Thwaites system was able to distinguish subacute bacterial meningitis from TBM (P < .001), but not to distinguish TBM from viral, fungal, unknown and miscellaneous causes of SAM.…”

Section: Discussionmentioning

confidence: 87%

“…2a). The Lancet scoring system was able to distinguish TBM from viral meningitis (P < .001) median 8 (5-11), fungal meningitis (P < .001) median 9 (5-18), bacterial meningitis (P < .001) median 8 (6-10), unknown causes of meningitis (P < .001), median 8 (1-18), and was not able to distinguish TBM form miscellaneous causes of meningitis (P = .255) median 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), (Fig. 2b).…”

Section: Etiologiesmentioning

confidence: 98%

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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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Section: Discussionmentioning

confidence: 87%

Section: Etiologiesmentioning

confidence: 98%

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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“…In addition, HIV positivity could influence the accuracy of the CPR, but a larger number of HIV‐positive patients than available in our series is needed to further explore this. HIV status can alter the inflammatory profile of the CSF and it seems to affect the performance of Thwaites’ index .…”

Section: Discussionmentioning

confidence: 99%

Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru

Solari

Soto

Stuyft

2018

Tropical Med Int Health

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“…tuberculosis is an aerobic, non-mobile, acid-fast bacillus that primarily infects humans and has no intermediate host [20]. Replication is relatively long (about 20 h) and requires several weeks of specific cultures such as Löwenstein-Jensen [13,14,22].…”

Section: Pathophysiology Of Tuberculosis In the Central Nervous Systemmentioning

confidence: 99%

Central nervous system and spinal cord tuberculosis: Revisiting an important disease

et al. 2021

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Validation of Thwaites Index for diagnosing tuberculous meningitis in a Colombian population

Cited by 13 publications

References 20 publications

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

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

Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru

Central nervous system and spinal cord tuberculosis: Revisiting an important disease

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