A diagnostic rule for tuberculous meningitis
Rashmi Kumara, S N Singha, Neera Kohlib
a Department of
Pediatrics, King George's Medical College, Lucknow, India 226003, b Department of
Radiodiagnosis, King George's Medical College
Correspondence to: Dr Kumar.
Accepted 15
February 1999
Diagnostic confusion often exists between tuberculous
meningitis and other meningoencephalitides. Newer diagnostic tests are unlikely to be available in many countries for some time. This study
examines which clinical features and simple laboratory tests can
differentiate tuberculous meningitis from other infections. Two hundred
and thirty two children (110 tuberculous meningitis, 94 non-tuberculous
meningitis, 28 indeterminate) with suspected meningitis and
cerebrospinal fluid (CSF) pleocytosis were enrolled. Tuberculous
meningitis was defined as positive CSF mycobacterial culture or acid
fast bacilli stain, or basal enhancement or tuberculoma on computed
tomography (CT) scan with clinical response to antituberculous treatment. Non-tuberculous meningitis was defined as positive CSF
bacterial culture or Gram stain, or clinical response without antituberculous treatment. Thirty clinical/laboratory features of
patients with tuberculous meningitis and non-tuberculous meningitis were compared by univariate and multiple logistic regression analysis. Five features were independently predictive of the diagnosis of tuberculous meningitis (p < 0.007): prodromal stage 
7 days, optic atrophy on fundal examination, focal deficit, abnormal movements, and CSF leucocytes < 50% polymorphs. When validated on another set
of 128 patients, if at least one feature was present, sensitivity was
98.4% and, if three or more were present, specificity was 98.3%. This
simple rule would be useful to physicians working in regions where
tuberculosis is prevalent.
Keywords: tuberculous meningitis; pyogenic meningitis; computed tomography scan
© 1999 by Archives of Disease in Childhood
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