Hakan Erdem1, Seniha Senbayrak2, Serap Gencer3, Rodrigo Hasbun4, Mustafa Kasim Karahocagil5, Gonul Sengoz6, Hasan Karsen7, Selçuk Kaya8, Rok Civljak9, Ayşe Seza Inal10, Abdullah Umut Pekok11, Mustafa Kemal Celen12, Secil Deniz2, Mehmet Ulug13, Tuna Demirdal14, Mustafa Namiduru15, Recep Tekin12, Tumer Guven16, Emine Parlak17, Sibel Bolukcu18, Meltem Avci19, Oğuz Reşat Sipahi18, Saygin Nayman-Alpat20, Kadriye Yaşar21, Filiz Pehlivanoğlu6, Emel Yilmaz22, Selma Ates-Guler23, Esmeray Mutlu-Yilmaz24, Selma Tosun19, Fatma Sirmatel25, Elif Şahin-Horasan26, Ayhan Akbulut27, Işik Somuncu Johansen28, Soline Simeon29, Ayşe Batirel3, Nefise Öztoprak30, Yasemin Cag3, Melanie Catroux31, Yves Hansmann32, Ayten Kadanali33, Huseyin Turgut34, Ali Irfan Baran5, Hanefi Cem Gul35, Gokhan Karaahmetoglu36, Mahmut Sunnetcioglu5, Asli Haykir-Solay37, Affan Denk27, Celal Ayaz12, Sukran Kose38, Levent Gorenek36. 1. GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. Electronic address: hakanerdem1969@yahoo.com. 2. Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 3. Lutfi Kirdar Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 4. The University of Texas Health Science Center at Houston, Medical School, Department of Infectious Diseases, USA. 5. Yuzuncuyil University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Van, Turkey. 6. Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 7. Harran University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sanliurfa, Turkey. 8. Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey. 9. Dr. Fran Mihaljevic University Hospital for Infectious Diseases, Department of Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia. 10. Cukurova University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey. 11. Private Erzurum Sifa Hospital, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey. 12. Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey. 13. Private Umit Hospital, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey. 14. Katip Celebi University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey. 15. Gaziantep University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Gaziantep, Turkey. 16. Ankara Atatürk Training & Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey. 17. Ataturk University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey. 18. Bezmi Alem Vakif University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 19. Izmir Bozyaka Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey. 20. Osmangazi University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey. 21. Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 22. Uludag University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey. 23. Sutcu Imam University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kahramanmaras, Turkey. 24. Samsun Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey. 25. Izzet Baysal University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bolu, Turkey. 26. Mersin University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey. 27. Firat University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Elazig, Turkey. 28. Odense University Hospital, Department of Infectious Diseases Q, Odense, Denmark. 29. University Hospital of Pontchaillou, Department of Infectious and Tropical Diseases, Rennes, France. 30. Antalya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey. 31. Poitiers University Hospital, Department of Infectious Diseases, France. 32. University Hospital, Department of Infectious Diseases, Strasbourg, France. 33. Umraniye Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 34. Pamukkale University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Denizli, Turkey. 35. Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey. 36. GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 37. Igdir State Hospital, Department of Infectious Diseases and Clinical Microbiology, Igdir, Turkey. 38. Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
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.
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.