Annals of Indian Academy of Neurology
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ORIGINAL ARTICLE
Year : 2017  |  Volume : 20  |  Issue : 4  |  Page : 363-366

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


1 Department of Adults, National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest 021105; Department of Infectious Diseases, University of Medicine and Pharmacy “Carol Davila”, Bucharest 020022, Romania
2 Division of Clinical Infectious Diseases, Research Center Borstel, Borstel 23845, Germany; Department of Clinical Microbiology, University Hospitals of Leicester, Leicester, United Kingdom
3 Department of Adults, National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest 021105, Romania

Correspondence Address:
Adriana Hristea
National Institute for Infectious Diseases “Prof Dr Matei Bals”; No. 1 Calistrat Grozovici Street, Sector 2, Bucharest 021105
Romania
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aian.AIAN_219_17

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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.


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