title: Tuberculous and brucellosis meningitis differential diagnosis.
abstract: BACKGROUND
  The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tuberculous meningitis (TBM). However, brucellar meningoencephalitis (BME) has similar characteristics with TBM. The ultimate aim of this study is to infer data to see if BME should be included in the differential diagnosis of TBM when these two systems suggest the presence of TBM.
  
  
  METHODS
  BME and TBM patients from 35 tertiary hospitals were included in this study. Overall 294 adult patients with BME and 190 patients with TBM were enrolled. All patients involved in the study had microbiological confirmation for either TBM or BME. Finally, the Thwaites and Lancet scoring systems were assessed in both groups.
  
  
  RESULTS
  The Thwaites scoring system more frequently predicted BME cases (n = 292, 99.3%) compared to the TBM group (n = 182, 95.8%) (P = 0.017). According to the Lancet scoring system, the mean scores for BME and TBM were 9.43 ± 1.71 and 11.45 ± 3.01, respectively (P < 0.001). In addition, TBM cases were classified into "probable" category more significantly compared to BME cases, and BME cases were categorized into the "possible" category more frequently.
  
  
  CONCLUSIONS
  When the Thwaites or Lancet scoring systems indicate TBM, brucellar etiology should also be taken into consideration particularly in endemic countries.
authors: GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. Electronic address: hakanerdem1969@yahoo.com.
authors: Hakan
authors: H
authors: Erdem
authors: Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Seniha
authors: S
authors: Senbayrak
authors: Lutfi Kirdar Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Serap
authors: S
authors: Gencer
authors: The University of Texas Health Science Center at Houston, Medical School, Department of Infectious Diseases, USA.
authors: Rodrigo
authors: R
authors: Hasbun
authors: Yuzuncuyil University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Van, Turkey.
authors: Mustafa Kasim
authors: MK
authors: Karahocagil
authors: Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Gonul
authors: G
authors: Sengoz
authors: Harran University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sanliurfa, Turkey.
authors: Hasan
authors: H
authors: Karsen
authors: Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey.
authors: Selçuk
authors: S
authors: Kaya
authors: Dr. Fran Mihaljevic University Hospital for Infectious Diseases, Department of Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia.
authors: Rok
authors: R
authors: Civljak
authors: Cukurova University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey.
authors: Ayşe Seza
authors: AS
authors: Inal
authors: Private Erzurum Sifa Hospital, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey.
authors: Abdullah Umut
authors: AU
authors: Pekok
authors: Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey.
authors: Mustafa Kemal
authors: MK
authors: Celen
authors: Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Secil
authors: S
authors: Deniz
authors: Private Umit Hospital, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey.
authors: Mehmet
authors: M
authors: Ulug
authors: Katip Celebi University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
authors: Tuna
authors: T
authors: Demirdal
authors: Gaziantep University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Gaziantep, Turkey.
authors: Mustafa
authors: M
authors: Namiduru
authors: Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey.
authors: Recep
authors: R
authors: Tekin
authors: Ankara Atatürk Training & Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors: Tumer
authors: T
authors: Guven
authors: Ataturk University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey.
authors: Emine
authors: E
authors: Parlak
authors: Bezmi Alem Vakif University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Sibel
authors: S
authors: Bolukcu
authors: Izmir Bozyaka Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
authors: Meltem
authors: M
authors: Avci
authors: Bezmi Alem Vakif University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Oğuz Reşat
authors: OR
authors: Sipahi
authors: Osmangazi University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey.
authors: Saygin
authors: S
authors: Nayman-Alpat
authors: Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Kadriye
authors: K
authors: Yaşar
authors: Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Filiz
authors: F
authors: Pehlivanoğlu
authors: Uludag University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey.
authors: Emel
authors: E
authors: Yilmaz
authors: Sutcu Imam University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kahramanmaras, Turkey.
authors: Selma
authors: S
authors: Ates-Guler
authors: Samsun Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey.
authors: Esmeray
authors: E
authors: Mutlu-Yilmaz
authors: Izmir Bozyaka Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
authors: Selma
authors: S
authors: Tosun
authors: Izzet Baysal University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bolu, Turkey.
authors: Fatma
authors: F
authors: Sirmatel
authors: Mersin University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey.
authors: Elif
authors: E
authors: Şahin-Horasan
authors: Firat University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Elazig, Turkey.
authors: Ayhan
authors: A
authors: Akbulut
authors: Odense University Hospital, Department of Infectious Diseases Q, Odense, Denmark.
authors: Işik Somuncu
authors: IS
authors: Johansen
authors: University Hospital of Pontchaillou, Department of Infectious and Tropical Diseases, Rennes, France.
authors: Soline
authors: S
authors: Simeon
authors: Lutfi Kirdar Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Ayşe
authors: A
authors: Batirel
authors: Antalya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey.
authors: Nefise
authors: N
authors: Öztoprak
authors: Lutfi Kirdar Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Yasemin
authors: Y
authors: Cag
authors: Poitiers University Hospital, Department of Infectious Diseases, France.
authors: Melanie
authors: M
authors: Catroux
authors: University Hospital, Department of Infectious Diseases, Strasbourg, France.
authors: Yves
authors: Y
authors: Hansmann
authors: Umraniye Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Ayten
authors: A
authors: Kadanali
authors: Pamukkale University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Denizli, Turkey.
authors: Huseyin
authors: H
authors: Turgut
authors: Yuzuncuyil University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Van, Turkey.
authors: Ali Irfan
authors: AI
authors: Baran
authors: Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors: Hanefi Cem
authors: HC
authors: Gul
authors: GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Gokhan
authors: G
authors: Karaahmetoglu
authors: Yuzuncuyil University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Van, Turkey.
authors: Mahmut
authors: M
authors: Sunnetcioglu
authors: Igdir State Hospital, Department of Infectious Diseases and Clinical Microbiology, Igdir, Turkey.
authors: Asli
authors: A
authors: Haykir-Solay
authors: Firat University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Elazig, Turkey.
authors: Affan
authors: A
authors: Denk
authors: Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey.
authors: Celal
authors: C
authors: Ayaz
authors: Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
authors: Sukran
authors: S
authors: Kose
authors: GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Levent
authors: L
authors: Gorenek
mesh_terms: D000328:Adult; D002006:Brucellosis / Q000175:diagnosis* / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000453:epidemiology; D014421:Turkey; D055815:Young Adult
keywords: Brucellosis; Diagnosis; Meningitis; Tuberculosis