Document Detail

Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features.
MedLine Citation:
PMID:  12414204     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The diagnosis of tuberculous meningitis is difficult. Discrimination of cases from those of bacterial meningitis by clinical features alone is often impossible, and current laboratory methods remain inadequate or inaccessible in developing countries. We aimed to create a simple diagnostic aid for tuberculous meningitis in adults on the basis of clinical and basic laboratory features. METHODS: We compared the clinical and laboratory features on admission of 251 adults at an infectious disease hospital in Vietnam who satisfied diagnostic criteria for tuberculous (n=143) or bacterial (n=108) meningitis. Features independently predictive of tuberculous meningitis were modelled by multivariate logistic regression to create a diagnostic rule, and by a classification-tree method. The performance of both diagnostic aids was assessed by resubstitution and prospective test data methods. FINDINGS: Five features were predictive of a diagnosis of tuberculous meningitis: age, length of history, white-blood-cell count, total cerebrospinal fluid white-cell count, and cerebrospinal fluid neutrophil proportion. A diagnostic rule developed from these features was 97% sensitive and 91% specific by resubstitution, and 86% sensitive and 79% specific when applied prospectively to a further 42 adults with tuberculous meningitis, and 33 with bacterial meningitis. The corresponding values for the classification tree were 99% and 93% by resubstitution, and 88% and 70% with prospective test data. INTERPRETATION: This study suggests that simple clinical and laboratory data can help in the diagnosis of adults with tuberculous meningitis. Although the usefulness of the diagnostic rule will vary depending on the prevalence of tuberculosis and HIV-1 infection, we suggest it be applied to adults with meningitis and a low cerebrospinal fluid glucose, particularly in settings with limited microbiological resources.
G E Thwaites; T T H Chau; K Stepniewska; N H Phu; L V Chuong; D X Sinh; N J White; C M Parry; J J Farrar
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Lancet     Volume:  360     ISSN:  0140-6736     ISO Abbreviation:  Lancet     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-11-04     Completed Date:  2002-12-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  1287-92     Citation Subset:  AIM; IM    
University of Oxford-Wellcome Trust Clinical Research Unit, Centre for Tropical Diseases, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Viet Nam.
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MeSH Terms
Age Factors
Bacterial Infections / diagnosis
Cerebrospinal Fluid / cytology
Decision Trees
Leukocyte Count
Middle Aged
Neutrophils / cytology
Regression Analysis
Sensitivity and Specificity
Tuberculosis, Meningeal / diagnosis*

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