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. 2015 Mar-Apr;13(2):185-91.
doi: 10.1016/j.tmaid.2015.02.008. Epub 2015 Mar 11.

Tuberculous and brucellosis meningitis differential diagnosis

Hakan Erdem  1 , Seniha Senbayrak  2 , Serap Gencer  3 , Rodrigo Hasbun  4 , Mustafa Kasim Karahocagil  5 , Gonul Sengoz  6 , Hasan Karsen  7 , Selçuk Kaya  8 , Rok Civljak  9 , Ayşe Seza Inal  10 , Abdullah Umut Pekok  11 , Mustafa Kemal Celen  12 , Secil Deniz  2 , Mehmet Ulug  13 , Tuna Demirdal  14 , Mustafa Namiduru  15 , Recep Tekin  12 , Tumer Guven  16 , Emine Parlak  17 , Sibel Bolukcu  18 , Meltem Avci  19 , Oğuz Reşat Sipahi  18 , Saygin Nayman-Alpat  20 , Kadriye Yaşar  21 , Filiz Pehlivanoğlu  6 , Emel Yilmaz  22 , Selma Ates-Guler  23 , Esmeray Mutlu-Yilmaz  24 , Selma Tosun  19 , Fatma Sirmatel  25 , Elif Şahin-Horasan  26 , Ayhan Akbulut  27 , Işik Somuncu Johansen  28 , Soline Simeon  29 , Ayşe Batirel  3 , Nefise Öztoprak  30 , Yasemin Cag  3 , Melanie Catroux  31 , Yves Hansmann  32 , Ayten Kadanali  33 , Huseyin Turgut  34 , Ali Irfan Baran  5 , Hanefi Cem Gul  35 , Gokhan Karaahmetoglu  36 , Mahmut Sunnetcioglu  5 , Asli Haykir-Solay  37 , Affan Denk  27 , Celal Ayaz  12 , Sukran Kose  38 , Levent Gorenek  36
Affiliations

Tuberculous and brucellosis meningitis differential diagnosis

Hakan Erdem et al. Travel Med Infect Dis. 2015 Mar-Apr.

Abstract

Background: The Thwaites and Lancet scoring systems have been used in the rapid diagnosis of tuberculous meningitis (TBM). However, brucellar meningoencephalitis (BME) has similar characteristics with TBM. The ultimate aim of this study is to infer data to see if BME should be included in the differential diagnosis of TBM when these two systems suggest the presence of TBM.

Method: BME and TBM patients from 35 tertiary hospitals were included in this study. Overall 294 adult patients with BME and 190 patients with TBM were enrolled. All patients involved in the study had microbiological confirmation for either TBM or BME. Finally, the Thwaites and Lancet scoring systems were assessed in both groups.

Results: The Thwaites scoring system more frequently predicted BME cases (n = 292, 99.3%) compared to the TBM group (n = 182, 95.8%) (P = 0.017). According to the Lancet scoring system, the mean scores for BME and TBM were 9.43 ± 1.71 and 11.45 ± 3.01, respectively (P < 0.001). In addition, TBM cases were classified into "probable" category more significantly compared to BME cases, and BME cases were categorized into the "possible" category more frequently.

Conclusions: When the Thwaites or Lancet scoring systems indicate TBM, brucellar etiology should also be taken into consideration particularly in endemic countries.

Keywords: Brucellosis; Diagnosis; Meningitis; Tuberculosis.

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