title: Clinical prediction rule for differentiating tuberculous from viral meningitis.
abstract: METHODS
  The Professor Dr Matei Bals National Institute of Infectious Diseases, Bucharest, Romania.
  
  
  OBJECTIVE
  To create a prediction rule to enable clinicians to differentiate patients with tuberculous meningitis (TBM) from those with viral meningitis.
  
  
  METHODS
  We retrospectively  analysed patients admitted to a tertiary care facility between 2001 and 2011 with viral meningitis and TBM. Patients were defined as having TBM according to a recently published consensus definition, and as viral meningitis if a viral aetiology was confirmed, or after ruling out bacterial,  fungal and non-infectious causes of meningitis.
  
  
  RESULTS
  We identified 433 patients with viral meningitis and 101 TBM patients and compared their clinical and laboratory features. Multivariable analysis showed a statistically significant association between TBM and the following variables:  duration of symptoms before admission of ≥5 days, presence of neurological impairment (altered consciousness, seizures, mild focal signs, multiple cranial nerve palsies, dense hemiplegia or paraparesis), cerebrospinal fluid/blood glucose ratio < 0.5 and cerebrospinal fluid protein level  > 100 mg/dl. We propose a diagnostic score based on the coefficients derived from the logistic regression model with a sensitivity and specificity for TBM of respectively 92% and 94%.
  
  
  CONCLUSIONS
  Our study suggests that easily available clinical and laboratory data are very useful for  differentiating TBM from other causes of meningitis.
authors.affiliation: Professor Dr Matei Bals National Institute of Infectious Diseases, Bucharest, Romania. adriana_hristea@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Hristea
authors.forename: I D
authors.initials: ID
authors.lastname: Olaru
authors.forename: C
authors.initials: C
authors.lastname: Baicus
authors.forename: R
authors.initials: R
authors.lastname: Moroti
authors.forename: V
authors.initials: V
authors.lastname: Arama
authors.forename: M
authors.initials: M
authors.lastname: Ion
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002555:Cerebrospinal Fluid / Q000382:microbiology / Q000821:virology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012383:Romania; D012680:Sensitivity and Specificity; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D055815:Young Adult