Validation of Thwaites' Diagnostic Scoring System for the Differential Diagnosis of Tuberculous Meningitis and Bacterial Meningitis

Zhang, Yanliang; Lin, Su; Shao, Lingyun; Zhang, Wenhong; Weng, Xinhua

doi:10.7883/yoken.67.428

Cited by 18 publications

(14 citation statements)

References 16 publications

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“…Mustafa Sunbul et al evaluated Thwaites' score and sensitivity and specificity to diagnose TBM were 95% and 70% respectively [4]. In our study if only TBM and pyogenic meningitis were included for analysis (excluding cryptococcal meningitis etc), sensitivity and specificity of Thwaites' score to diagnose TBM were 96% and 70% respectively which was very similar to the findings of Mustafa Sunbul et al Zhang et al reported a sensitivity and specificity of 98.2 % and 43.6 % respectively [5]. In a study published by Roshin Kurien et al, Thwaites' score compared well with Lancet consensus score in diagnosing TBM.…”

Section: Discussionsupporting

confidence: 85%

Validation of Thwaites’ Diagnostic Score in Adults with Tuberculous Meningitis

Boorugu¹,

Reddy²,

Punjani³

2020

SASJM

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Section: Discussionsupporting

confidence: 85%

Validation of Thwaites’ Diagnostic Score in Adults with Tuberculous Meningitis

Boorugu¹,

Reddy²,

Punjani³

2020

SASJM

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“…Their evaluation revealed the sensitivity and specificity of the system to be 95.6 and 70.8%, respectively. Zhang et al evaluated Thwaites scoring system and concluded to be highly effective for the differential diagnosis of TBM and initially treated bacterial meningitis but were found to be less effective for that of TBM and partially treated bacterial meningitis [13]. J.…”

Section: Discussionmentioning

confidence: 99%

“…S Sebastian et al evaluated Thwaites scoring system in 527 patients (adults and pediatrics), and concluded that the scoring system was sensitive but not specific when used to distinguish TBM from bacterial meningitis in HIV negative adults. In HIV positive adults the index had low diagnostic accuracy [13].…”

Section: Discussionmentioning

confidence: 99%

“…2a). The Lancet scoring system was able to distinguish TBM from viral meningitis (P < .001) median 8 (5-11), fungal meningitis (P < .001) median 9 (5-18), bacterial meningitis (P < .001) median 8 (6-10), unknown causes of meningitis (P < .001), median 8 (1-18), and was not able to distinguish TBM form miscellaneous causes of meningitis (P = .255) median 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), (Fig. 2b).…”

Section: Etiologiesmentioning

confidence: 98%

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The diagnostic utility of the “Thwaites’ system” and “lancet consensus scoring system” in tuberculous vs. non-tuberculous subacute and chronic meningitis: multicenter analysis of 395 adult patients

et al. 2020

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Background Tuberculous meningitis (TBM) represents a diagnostic and management challenge to clinicians. The “Thwaites’ system” and “Lancet consensus scoring system” are utilized to differentiate TBM from bacterial meningitis but their utility in subacute and chronic meningitis where TBM is an important consideration is unknown. Methods A multicenter retrospective study of adults with subacute and chronic meningitis, defined by symptoms greater than 5 days and less than 30 days for subacute meningitis (SAM) and greater than 30 days for chronic meningitis (CM). The “Thwaites’ system” and “Lancet consensus scoring system” scores and the diagnostic accuracy by sensitivity, specificity, and area under the curve of receiver operating curve (AUC-ROC) were calculated. The “Thwaites’ system” and “Lancet consensus scoring system” suggest a high probability of TBM with scores ≤4, and with scores of ≥12, respectively. Results A total of 395 patients were identified; 313 (79.2%) had subacute and 82 (20.8%) with chronic meningitis. Patients with chronic meningitis were more likely caused by tuberculosis and had higher rates of HIV infection (P < 0.001). A total of 162 patients with TBM and 233 patients with non-TBM had unknown (140, 60.1%), fungal (41, 17.6%), viral (29, 12.4%), miscellaneous (16, 6.7%), and bacterial (7, 3.0%) etiologies. TMB patients were older and presented with lower Glasgow coma scores, lower CSF glucose and higher CSF protein (P < 0.001). Both criteria were able to distinguish TBM from bacterial meningitis; only the Lancet score was able to differentiate TBM from fungal, viral, and unknown etiologies even though significant overlap occurred between the etiologies (P < .001). Both criteria showed poor diagnostic accuracy to distinguish TBM from non-TBM etiologies (AUC-ROC was <. 5), but Lancet consensus scoring system was fair in diagnosing TBM (AUC-ROC was .738), sensitivity of 50%, and specificity of 89.3%. Conclusion Both criteria can be helpful in distinguishing TBM from bacterial meningitis, but only the Lancet consensus scoring system can help differentiate TBM from meningitis caused by fungal, viral and unknown etiologies even though significant overlap occurs and the overall diagnostic accuracy of both criteria were either poor or fair.

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“…Until recently, diagnosis of TBM depended on various tests including X-pert MTB/rifampicin (RIF) and IGRA 12 27 28 and clinical criteria. 11 13 29 30 However, the diagnostic sensitivity and specificity of these tests vary from one dataset to another. TB culture of the CSF is still accepted as the only confirmatory test.…”

Section: Discussionmentioning

confidence: 99%

A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis

et al. 2018

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BackgroundTuberculous meningitis (TBM) is associated with high mortality and morbidity despite administering anti-tuberculous chemotherapy to the patients. Differential diagnosis between TBM and viral meningitis (VM) is difficult in some clinical situations.MethodsWe reviewed and analyzed records of adult patients who were admitted and diagnosed with TBM or VM at a tertiary hospital in Korea, between January 2006 and December 2015. Diagnostic criteria for TBM were categorized into three groups: definite, probable, and possible TBM. The VM group included patients with no evidence of other meningitis who achieved complete recovery with only conservative treatments. Clinical, laboratory and radiological findings, as well as outcomes, were compared between the TBM and VM groups.ResultsNinety-eight patients were enrolled. Among the study patients, 47 had TBM and 51 had VM. Based on univariate analysis and multivariate logistic regression, sodium < 135 mmol/L in serum (hyponatremia), lactate dehydrogenase > 70 (U/L) in cerebrospinal fluid (CSF), protein > 160 (mg/dL) in CSF, voiding difficulty, and symptoms of cranial nerve palsy were significant predictive factors for TBM in the final model. We constructed a weighted scoring system with predictive factors from multiple regression analyses. Receiver operating characteristic curve analyses and decision tree analyses were plotted to reveal an optimum cutoff point as 4 with this scoring system (range: 0–13).ConclusionFor differential diagnosis between TBM and VM, we created a new weighted scoring system. This scoring system and decision tree analysis are simple and easy to apply in clinical practice to differentiate TBM from VM.

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Validation of Thwaites' Diagnostic Scoring System for the Differential Diagnosis of Tuberculous Meningitis and Bacterial Meningitis

Cited by 18 publications

References 16 publications

Validation of Thwaites’ Diagnostic Score in Adults with Tuberculous Meningitis

Validation of Thwaites’ Diagnostic Score in Adults with Tuberculous Meningitis

The diagnostic utility of the “Thwaites’ system” and “lancet consensus scoring system” in tuberculous vs. non-tuberculous subacute and chronic meningitis: multicenter analysis of 395 adult patients

A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis

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