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...
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| Main Authors: | , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
14 July 2010
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| In: |
Tropical medicine & international health
Year: 2010, Volume: 15, Issue: 8, Pages: 910-917 |
| ISSN: | 1365-3156 |
| DOI: | 10.1111/j.1365-3156.2010.02565.x |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1111/j.1365-3156.2010.02565.x
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| Author Notes: | Danielle B. Cohen, Eduard E. Zijlstra, Mavuto Mukaka, Miriam Reiss, Shizzie Kamphambale, Maarten Scholing, Peter I. Waitt and Florian Neuhann |
| Summary: | 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. |
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| Item Description: | Gesehen am 10.05.2023 |
| Physical Description: | Online Resource |
| ISSN: | 1365-3156 |
| DOI: | 10.1111/j.1365-3156.2010.02565.x |