ArticleBMC infectious diseases2020
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.
Article in BMC infectious diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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13 citing papers in PubMed, 23 citations in OpenAlex.
- Diagnosis of Tuberculous Meningitis: Integrating Clinical Assessment and Molecular Diagnostics.Diagnostics (Basel, Switzerland) · 2026Review
- Article
- Tuberculous Meningitis Complicated by Communicating Hydrocephalus and Lacunar Infarcts: A Case Report.Cureus · 2025Article
- Chronic meningitis: diagnostic and therapeutic challenges.Current opinion in infectious diseases · 2025Review
- Opsoclonus Myoclonus Ataxia Syndrome: An Atypical Presentation of Tuberculous Meningitis.The American journal of tropical medicine and hygiene · 2025Article
- Cytochemical analysis of cerebrospinal fluid in tuberculous meningitis versus other etiologies.PloS one · 2025Article
- A comparison of clinical features between neurobrucellosis and tuberculous meningitis.BMC neurology · 2024Article
- Characteristics of Tuberculous Meningitis in HIV-Positive Patients from Northeast Romania.Clinics and practice · 2023Article
- Tuberculostearic acid incorporated predictive model contributes to the clinical diagnosis of tuberculous meningitis.iScience · 2023Article
- Leukotriene A4 hydrolase (LTA4H rs17525495) gene polymorphisms and paradoxical reactions in extrapulmonary tuberculosis.Scientific reports · 2023Article
- Assessing the impact of pregnancy and birth factors on the maternal and infant microbiota.Microbiome research reports · 2023Article
- Clinical Management of Pathogen-Negative Tuberculous Meningitis in Adults: A Series Case Study.Journal of clinical medicine · 2022Article
- Pelvic and central nervous system tuberculosis complicated by a paradoxical response manifesting as a spinal tuberculoma: a case report.BMC infectious diseases · 2022Article
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41 authors at 20 institutions in 9 countries.
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Abstract
backgroundTuberculous 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.
methodsA 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.
resultsA 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%.
conclusionBoth 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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