title: Sensitivity and specificity of an index for the diagnosis of TB meningitis in patients in an urban teaching hospital in Malawi.
abstract: Tuberculous (TB) meningitis is difficult to diagnose and has a high mortality rate, particularly when presentation is delayed. A diagnostic index developed in Vietnam, an area of low-HIV seroprevalence, has been proposed as a means to differentiate TB meningitis from acute bacterial meningitis using clinical and laboratory features. We applied this index over a 4-month period to adults presenting with meningitis to an urban teaching hospital in Malawi, where HIV seroprevalence is 70% among medical inpatients. Eighty-five consecutive eligible patients were studied. Nine had TB meningitis, 64 bacterial meningitis and 12 cryptococcal meningitis. The sensitivity of the diagnostic index for predicting TB meningitis was 78%, with a specificity of 43%, too low to be used in the diagnosis of TB meningitis in this setting. This finding is likely to be generalizable to other southern African countries with similarly high-HIV seroprevalences.
authors.affiliation: Queen Elizabeth Central Hospital, Malawi. annacheckley@yahoo.com
authors.forename: Anna M
authors.initials: AM
authors.lastname: Checkley
authors.forename: Yasin
authors.initials: Y
authors.lastname: Njalale
authors.forename: Matthew
authors.initials: M
authors.lastname: Scarborough
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Zjilstra
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D015528:HIV Seroprevalence; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000453:epidemiology; D016919:Meningitis, Cryptococcal / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012680:Sensitivity and Specificity; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000453:epidemiology