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Table 2 Lancet scoring system

From: The diagnostic utility of the “Thwaites’ system” and “lancet consensus scoring system” in tuberculous vs. non-tuberculous subacute and chronic meningitis: multicenter analysis of 395 adult patients

Clinical criteria Score (Maximum category score = 6)
 Symptom duration of more than 5 days 4
 Systemic symptoms suggestive of tuberculosis (one or more of the following): weight loss (or poor weight gain in children), night sweats, or persistent cough for more than 2 weeks 2
 History of recent (within past year) close contact with an individual with pulmonary tuberculosis or a positive TST or IGRA (only in children < 10 years of age) 2
 Focal neurological deficit (excluding cranial nerve palsies) 1
 Cranial nerve palsy 1
 Altered consciousness 1
CSF criteria (Maximum category score = 4)
 Clear appearance 1
 Cells: 10–500 per μl 1
 Lymphocytic predominance (> 50%) 1
 Protein concentration greater than 1 g/L 1
 CSF to plasma glucose ratio of less than 50% or an absolute CSF glucose concentration less than 2·2 mmol/L 1
Cerebral imaging criteria (Maximum category score = 6)
 Hydrocephalus 1
 Basal meningeal enhancement 2
 Tuberculoma 2
 Infarct 1
 Pre-contrast basal hyperdensity 2
Evidence of tuberculosis elsewhere (Maximum category score = 4)
 Chest radiograph suggestive of active tuberculosis: signs of tuberculosis = 2; miliary tuberculosis = 4 2/4
 CT/ MRI/ ultrasound evidence for tuberculosis outside the CNS 2
 AFB identified or Mycobacterium tuberculosis cultured from another source—i.e., sputum lymph node, gastric washing, urine, blood culture 4
 Positive commercial M tuberculosis NAAT from extra-neural specimen 4
  1. Exclusion of alternative diagnoses
  2. An alternative diagnosis must be confirmed microbiologically (by stain, culture, or NAAT when appropriate), serologically (eg, syphilis), or histopathologically (eg, lymphoma). The list of alternative diagnoses that should be considered, dependent upon age, immune status, and geographical region, include: pyogenic bacterial meningitis, cryptococcal meningitis, syphilitic meningitis, viral meningo-encephalitis, cerebral malaria, parasitic or eosinophilic meningitis (Angiostrongylus cantonesis, Gnathostoma spinigerum, toxocariasis, cysticercosis), cerebral toxoplasmosis and bacterial brain abscess (space-occupying lesion on cerebral imaging) and malignancy (eg, lymphoma)
  3. TST tuberculin skin test, IGRA interferon-gamma release assay, NAAT nucleic acid amplification test, AFB acid-fast bacilli. The individual points for each criterion (one, two, or four points) were determined by consensus and by considering their quantified diagnostic value as defined in studies