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Clinical value of a uniform research case definition of tuberculous meningitis

dc.contributor.advisorSolomons, Regan Shaneen_ZA
dc.contributor.authorWessels, Marieen_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.en_ZA
dc.date.accessioned2014-04-16T17:33:31Z
dc.date.available2015-01-02T03:00:05Z
dc.date.issued2014-04en_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/86775
dc.descriptionThesis (MMed)--Stellenbosch University, 2014.en_ZA
dc.description.abstractENGLISH 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.en_ZA
dc.format.extent21 pagesen_ZA
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch Universityen_ZA
dc.subjectMeningitis in childrenen_ZA
dc.subjectMeninges -- Tuberculosis -- Diagnosisen_ZA
dc.subjectMeninges -- Tuberculosis -- Treatmenten_ZA
dc.subjectUCTDen_ZA
dc.titleClinical value of a uniform research case definition of tuberculous meningitisen_ZA
dc.typeThesisen_ZA
dc.rights.holderStellenbosch Universityen_ZA
dc.embargo.terms2015-01-01


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