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Free Content Clinical prediction rule for differentiating tuberculous from viral meningitis

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SETTING: The Professor Dr Matei Bals National Institute of Infectious Diseases, Bucharest, Romania.

OBJECTIVE: To create a prediction rule to enable clinicians to differentiate patients with tuberculous meningitis (TBM) from those with viral meningitis.

DESIGN: We retrospectively analysed patients admitted to a tertiary care facility between 2001 and 2011 with viral meningitis and TBM. Patients were defined as having TBM according to a recently published consensus definition, and as viral meningitis if a viral aetiology was confirmed, or after ruling out bacterial, fungal and non-infectious causes of meningitis.

RESULTS: We identified 433 patients with viral meningitis and 101 TBM patients and compared their clinical and laboratory features. Multivariable analysis showed a statistically significant association between TBM and the following variables: duration of symptoms before admission of ≥5 days, presence of neurological impairment (altered consciousness, seizures, mild focal signs, multiple cranial nerve palsies, dense hemiplegia or paraparesis), cerebrospinal fluid/blood glucose ratio < 0.5 and cerebrospinal fluid protein level > 100 mg/dl. We propose a diagnostic score based on the coefficients derived from the logistic regression model with a sensitivity and specificity for TBM of respectively 92% and 94%.

CONCLUSIONS: Our study suggests that easily available clinical and laboratory data are very useful for differentiating TBM from other causes of meningitis.

Keywords: central nervous system infections; diagnostic score; tuberculosis

Document Type: Research Article

DOI: http://dx.doi.org/10.5588/ijtld.11.0687

Affiliations: 1: Professor Dr Matei Bals National Institute of Infectious Diseases, Bucharest, Romania; and Carol Davila University of Medicine and Pharmacy, Bucharest, Romania 2: Professor Dr Matei Bals National Institute of Infectious Diseases, Bucharest, Romania 3: Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; and Third Department of Internal Medicine, Colentina Hospital, Bucharest, Romania

Publication date: June 1, 2012

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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