Clinical value of a uniform research case definition of tuberculous meningitis
Date
2014-04
Authors
Wessels, Marie
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: BACKGROUND: Tuberculous meningitis (TBM) research remains important but
obtaining adequate sample sizes of microbiologically-confirmed TBM cases is difficult,
therefore clinical cases of TBM need to be included. A uniform research case definition
for TBM was developed to assist diagnostic standardization.
METHODS: Our study evaluated the proposed uniform research case definition in a
group of children diagnosed with TBM. A subgroup of 66 children with cultureconfirmed
TBM 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%) had
possible TBM. Symptom duration >5 days, weight loss or persistent cough >2 weeks,
recent TB contact, focal neurological deficit, clear cerebrospinal fluid (CSF) appearance
and basal meningeal enhancement predicted TBM when compared to definite bacterial
meningitis with a sensitivity and specificity of 97.0% and 93.7%, respectively. When
using a probable TBM score as the diagnostic measure, sensitivity was 86% and
specificity 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 when
using a probable TBM score as the diagnostic marker. A regression model also
differentiated TBM from bacterial meningitis with good accuracy, but caution is needed
in its application to early TBM.
Description
Thesis (MMed)--Stellenbosch University, 2014.
Keywords
Meningitis in children, Meninges -- Tuberculosis -- Diagnosis, Meninges -- Tuberculosis -- Treatment, UCTD