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Table 4 Etiologies, “Thwaites system and Lancet consensus scoring system” in 395 adults with subacute/chronic meningitis

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

Etiology Thwaites Scoring Classificationa Lancet Scoring Classificationb
(n = 395) ≤4 points
(Possible TBM)
>  4 points
(Possible BM)
Definite TBM
Positive TB Culture
Probable
≥12 points
Possible
6─11 points
No TBM
<  6 points
TBMc (162) 160 2 162 81 81 0
Fungald (41) 41 0 0 5 35 1
Virale (29) 29 0 0 0 28 1
Bacterialf (7) 6 1 0 0 7 0
Miscellaneousg (16) 16 0 0 6 10 0
Unknownh (140) 139 1 0 14 123 3
  1. aIf a patient has a total score of 4 or less, the patient is classified as tubercular meningitis (TBM) and a score of more than 4 is suggestive of bacterial meningitis
  2. bDefinite diagnosis of TBM is made if there is evidence of Acid Fast Bacilli (AFB) in CSF smear, culture or on histopathology of brain or spinal cord. A probable diagnosis is made if the total score is >10 points if patients have no imaging, or >11 points if imaging was used. A possible diagnosis is made with scores between 6-9 points without imaging or 6-11 with imaging. No TBM if the total score < 6 points
  3. c162 cases of CSF Culture positive for TB Complex, although all 162 cases are definite TBM , we calculated the actual Lancet score
  4. d36 cases of Cryptococcal Meningitis , 3 cases Coccidiosis Meningitis, 2 cases of Histoplasma Meningitis
  5. e10 cases of Herpes simplex 1 & 2, 8 cases of West Nile Virus, 4 cases of Varicella Zoster Virus, 3 cases of Saint Louis Virus, 2 Cases of Enterovirus, 2 cases of acute HIV
  6. f3 cases of Streptococcus pneumoniae , 1 case of Methicillin Sensitive Staphylococcus Aureus , 1 case of Haemophilus influenzae , 1 case of Group A Streptococcus , 1 case of coagulase negative staphylococcus
  7. gMiscellaneous etiologies includes: non-infectious etiologies: 5 cases of Systemic lupus erythematosus meningoencephalitis, 2 cases of para neoplastic (1 case due Breast cancer, 1 case due to anti NMDA), 2 cases of Neurosarcoidosis, 1 case of Meningeal Carcinomatosis, 1 case of disseminated encephalomyelitis (ADEM), 1 case of Central Nervous System Lymphoma. Parasitic infections etiologies: 2 cases of Cerebral Toxoplasmosis, 2 cases of Neurocysticercosis
  8. hUnknown cause of meningitis