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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Diagnosis of cryptococcal and tuberculous meningitis in a resource-limited African setting
Tropical Medicine and International Health, Volume 15, No. 8, Year 2010
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Description
SummaryObjectives 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. © 2010 Blackwell Publishing Ltd.
Authors & Co-Authors
Cohen, Daniëlle
Malawi, Zomba
University of Malawi
Zijlstra, Eduard Evert
Malawi, Zomba
University of Malawi
Mukaka, Mavuto F.J.
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Reiss, Miriam
Germany, Heidelberg
Universitätsklinikum Heidelberg
Kamphambale, Shizzie
Malawi, Zomba
University of Malawi
Scholing, Maarten
Netherlands, Amsterdam
Amsterdam Umc - Vrije Universiteit Amsterdam
Waitt, Peter I.
Malawi, Zomba
University of Malawi
Neuhann, H. Florian
Germany, Heidelberg
Universitätsklinikum Heidelberg
Statistics
Citations: 73
Authors: 8
Affiliations: 4
Identifiers
Doi:
10.1111/j.1365-3156.2010.02565.x
ISSN:
13602276
e-ISSN:
13653156
Research Areas
Health System And Policy
Infectious Diseases