Development and validation of a new scoring system for the early diagnosis of tuberculous meningitis in adults

Yuying Lu,Caiyu Ma,Ru Chen,Zhongyang Hu,Huan Yao,Qinghua Zhang,Haixia Zhu,Zhen Wang,Zhi Song,Chen Zhang,Ding Liu

doi:10.1016/j.diagmicrobio.2021.115393

Abstract

We developed and validated a new diagnostic scoring system by simultaneously comparing 28 factors (including clinical, laboratory, and imaging) of HIV uninfected adult tuberculous meningitis (TBM) with viral meningitis (VM), bacterial meningitis (BM), and cryptococcal meningitis (CM). Predictors of TBM diagnosis obtained by logistic regression. A total of 382 patients with intracranial infection participated, and eight factors were independently associated with TBM diagnosis: symptom duration, evidence of extracranial tuberculosis, cerebrospinal fluid (CSF) leukocyte, CSF neutrophil, CSF protein, low serum sodium, meningeal enhancement, and tuberculomas. Factors are assigned according to weight, a score of ≥ 5 was suggestive of TBM with a sensitivity of 85.8% and a specificity of 87.7%, and the area under the receiver operating characteristic curve was 0.923. When applied to a prospective validation cohort, this scoring model showed robust performance. Our study suggests that the application of this score can help diagnose TBM more efficiently.

Highlights

The absence of a sufficiently accurate and efficient diagnosis of tuberculous meningitis (TBM) is major obstacle to delayed treatment, and its non-specific clinical manifestations mimic the central nervous system infections caused by other causes, including virus, bacteria, and cryptococcus
Nine factors independently associated with the diagnosis of TBM: symptom duration (10–30 days), systemic symptoms, evidence of extra-central nervous system tuberculosis, cerebrospinal fluid (CSF) leukocyte count (100-500∗106 /mL), CSF neutrophil proportion (20%-75%), CSF protein (> 1 g/L), low serum sodium (< 137 mmol/L), meningeal enhancement, and brain parenchymal nodules
For differential diagnosis between TBM and other causes of meningitis (VM,cryptococcal meningitis (CM) and bacterial meningitis (BM)), we developed and validated a new weighted scoring system

Summary

Introduction

The absence of a sufficiently accurate and efficient diagnosis of tuberculous meningitis (TBM) is major obstacle to delayed treatment, and its non-specific clinical manifestations mimic the central nervous system infections caused by other causes, including virus, bacteria, and cryptococcus. This study aims to develop and validate a diagnostic score system for TBM in HIV-uninfected adults by simultaneously comparing TBM with viral meningitis (VM), bacterial meningitis (BM), and cryptococcal meningitis (CM)

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