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

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dc.authoridVAHABOGLU, Haluk/0000-0001-8217-1767
dc.authoridINAL, AYSE SEZA/0000-0002-1182-7164
dc.authoridOruc, Ebru/0000-0001-7956-7306
dc.authoridErdem, Hakan/0000-0002-6265-5227
dc.authoridCag, Yasemin/0000-0002-9983-0308
dc.authoridPehlivanoglu, Filiz/0000-0001-9943-6004
dc.authoridjohansen, isik somuncu/0000-0002-2189-9823
dc.contributor.authorSulaiman, Tarek
dc.contributor.authorMedi, Sai
dc.contributor.authorErdem, Hakan
dc.contributor.authorSenbayrak, Seniha
dc.contributor.authorOzturk-Engin, Derya
dc.contributor.authorInan, Asuman
dc.contributor.authorCivljak, Rok
dc.date.accessioned2025-01-27T20:34:37Z
dc.date.available2025-01-27T20:34:37Z
dc.date.issued2020
dc.departmentÇanakkale Onsekiz Mart Üniversitesi
dc.description.abstractBackground 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.
dc.description.sponsorshipNational Center for Research Resources [NIH-1 K23 RR018929-01A2]; Grant A Starr Foundation
dc.description.sponsorshipThis study was also supported by a grant from the National Center for Research Resources (NIH-1 K23 RR018929-01A2) (PI. Hasbun) and by the Grant A Starr Foundation. The funding agencies had no role on the design or analysis of the study.
dc.identifier.doi10.1186/s12879-020-05502-9
dc.identifier.issn1471-2334
dc.identifier.issue1
dc.identifier.pmid33096990
dc.identifier.scopus2-s2.0-85093973393
dc.identifier.scopusqualityQ2
dc.identifier.urihttps://doi.org/10.1186/s12879-020-05502-9
dc.identifier.urihttps://hdl.handle.net/20.500.12428/23388
dc.identifier.volume20
dc.identifier.wosWOS:000586401600004
dc.identifier.wosqualityQ3
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherBMC
dc.relation.ispartofBmc Infectious Diseases
dc.relation.publicationcategoryinfo:eu-repo/semantics/openAccess
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WoS_20250125
dc.subjectTuberculous
dc.subjectSubacute
dc.subjectMeningitis
dc.subjectThwaites
dc.subjectLancet
dc.subjectCriteria
dc.titleThe 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
dc.typeArticle

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