Tuberculosis versus pyogenic meningitis in a Pakistani population

Area of Science:

• Neurology
• Infectious Diseases
• Clinical Diagnostics

Background:

• Tuberculous meningitis (TBM) diagnosis requires reliable criteria.
• Existing criteria like Youssef (Rule 1) and Thwaites (Rule 2) have been studied in high TB prevalence areas.
• Comparing TBM features with acute bacterial meningitis is crucial for accurate diagnosis.

Purpose of the Study:

• To compare the diagnostic features of tuberculous meningitis (TBM) and acute bacterial meningitis.
• To evaluate the sensitivity and specificity of existing TBM diagnostic criteria.
• To assess the utility of CSF protein to glucose ratio in differentiating meningitis types.

Main Methods:

• A retrospective study was conducted at Northwest General Hospital & Research Centre, Peshawar, Pakistan.
• Patients with clinical diagnoses of TBM or bacterial meningitis were included.
• Receiver Operating Characteristic (ROC) curves were used to analyze diagnostic performance.

Main Results:

• Rule 1 (Youssef criteria) showed 97.5% sensitivity and 47.2% specificity at a cutoff of 2.
• Rule 2 (Thwaites criteria) demonstrated 95% sensitivity and 23.5% specificity at a cutoff of 3.5.
• CSF protein to glucose ratio had 93% sensitivity and 66.66% specificity at a cutoff of 2.

Conclusions:

• All evaluated indices exhibited high sensitivity for TBM diagnosis.
• The specificity of the studied criteria was not sufficiently high for definitive diagnosis.
• These indices are valuable for screening suspected TBM cases but require further confirmation before initiating therapy.