Diagnosis of cryptococcal and tuberculous meningitis in a resource-limited African setting.
OBJECTIVE
Cryptococcal meningitis (CM) and tuberculous meningitis (TBM) are common in HIV-infected adults in Africa and difficult to diagnose. Inaccurate diagnosis results in adverse outcomes. We describe patterns of meningitis in a Malawian hospital, focusing on features which differentiate CM and TBM with the aim to derive an algorithm using only clinical and basic laboratory data available in this resource-poor setting.


METHODS
Consecutive patients admitted with meningitis were prospectively recruited, clinical features were recorded and cerebrospinal fluid (CSF) was examined.


RESULTS
A total of 573 patients were recruited, and 263 (46%) had CSF consistent with meningitis. One hundred and twelve (43%) had CM and 46 (18%) had TBM. CM was associated with high CSF opening pressure and low CSF leukocyte count. Fever, neck stiffness and reduced conscious level were associated with TBM. A diagnostic index was constructed demonstrating sensitivity 83%and specificity 79% for the differentiation of CM and TBM. An algorithm was derived with 92% sensitivity for the diagnosis of CM, but only 58% specificity.


CONCLUSIONS
Although we demonstrate features associated with CM and TBM, a sufficiently sensitive and specific diagnostic algorithm could not be derived, suggesting that the diagnosis of CM and TBM in resource-limited settings still requires better access to laboratory tools.
Cohen
Danielle B
DB
College of Medicine University of Malawi, Blantyre, Malawi. danbcohen@yahoo.com
Zijlstra
Eduard E
EE
Mukaka
Mavuto
M
Reiss
Miriam
M
Kamphambale
Shizzie
S
Scholing
Maarten
M
Waitt
Peter I
PI
Neuhann
Florian
F
D017088:AIDS-Related Opportunistic Infections / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis*; D000328:Adult; D000465:Algorithms; D003906:Developing Countries; D003937:Diagnosis, Differential; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008295:Malawi; D008297:Male; D008507:Medically Underserved Area; D016919:Meningitis, Cryptococcal / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis*; D019547:Neck Pain / Q000382:microbiology; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis*