TY - JOUR
T1 - A new scoring system for the differential diagnosis between tuberculous meningitis and viral meningitis
AU - Lee, Sang Ah
AU - Kim, Shin Woo
AU - Chang, Hyun Ha
AU - Jung, Hyejin
AU - Kim, Yoonjung
AU - Hwang, Soyoon
AU - Kim, Sujeong
AU - Park, Han Ki
AU - Lee, Jong Myung
N1 - Publisher Copyright:
© 2018 The Korean Academy of Medical Sciences.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Background: Tuberculous 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. Methods: We 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. Results: Ninety-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 cutoffpoint as 4 with this scoring system (range: 0-13). Conclusion: For 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.
AB - Background: Tuberculous 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. Methods: We 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. Results: Ninety-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 cutoffpoint as 4 with this scoring system (range: 0-13). Conclusion: For 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.
KW - Scoring system
KW - Tuberculous meningitis
KW - Viral meningitis
UR - http://www.scopus.com/inward/record.url?scp=85050774542&partnerID=8YFLogxK
U2 - 10.3346/jkms.2018.33.e201
DO - 10.3346/jkms.2018.33.e201
M3 - Article
C2 - 30069169
AN - SCOPUS:85050774542
SN - 1011-8934
VL - 33
JO - Journal of Korean Medical Science
JF - Journal of Korean Medical Science
IS - 31
M1 - e201
ER -