Clinical value of a uniform research case definition of tuberculous meningitis

[摘要] ENGLISH ABSTRACT: BACKGROUND: Tuberculous meningitis (TBM) research remains important butobtaining adequate sample sizes of microbiologically-confirmed TBM cases is difficult,therefore clinical cases of TBM need to be included. A uniform research case definitionfor TBM was developed to assist diagnostic standardization.METHODS: Our study evaluated the proposed uniform research case definition in agroup of children diagnosed with TBM. A subgroup of 66 children with cultureconfirmedTBM was compared to culture-confirmed bacterial meningitis controls.RESULTS: The uniform case definition was applied to 554 TBM patients. Sixty-six(11.9%) patients had definite TBM, 408 (73.6%) had probable TBM and 72 (13.0%) hadpossible TBM. Symptom duration >5 days, weight loss or persistent cough >2 weeks,recent TB contact, focal neurological deficit, clear cerebrospinal fluid (CSF) appearanceand basal meningeal enhancement predicted TBM when compared to definite bacterialmeningitis with a sensitivity and specificity of 97.0% and 93.7%, respectively. Whenusing a probable TBM score as the diagnostic measure, sensitivity was 86% andspecificity was 100%. When using a possible TBM score as the diagnostic measure,sensitivity was 100% but specificity was 56%.CONCLUSION: The uniform research case definition for TBM performed well whenusing a probable TBM score as the diagnostic marker. A regression model alsodifferentiated TBM from bacterial meningitis with good accuracy, but caution is neededin its application to early TBM.

[发布机构] Stellenbosch University