Diagnosis of cryptococcal and tuberculous meningitis in a resource-limited African setting

OBJECTIVES: 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 an...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Hauptverfasser: Cohen, Danielle B. (VerfasserIn) , Zijlstra, Eduard E. (VerfasserIn) , Mukaka, Mavuto (VerfasserIn) , Reiss, Miriam (VerfasserIn) , Kamphambale, Shizzie (VerfasserIn) , Scholing, Maarten (VerfasserIn) , Waitt, Peter I. (VerfasserIn) , Neuhann, Florian (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: 14 July 2010
In: Tropical medicine & international health
Year: 2010, Jahrgang: 15, Heft: 8, Pages: 910-917
ISSN:1365-3156
DOI:10.1111/j.1365-3156.2010.02565.x
Online-Zugang:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1111/j.1365-3156.2010.02565.x
Volltext
Verfasserangaben:Danielle B. Cohen, Eduard E. Zijlstra, Mavuto Mukaka, Miriam Reiss, Shizzie Kamphambale, Maarten Scholing, Peter I. Waitt and Florian Neuhann
Beschreibung
Zusammenfassung:OBJECTIVES: 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.
Beschreibung:Gesehen am 10.05.2023
Beschreibung:Online Resource
ISSN:1365-3156
DOI:10.1111/j.1365-3156.2010.02565.x