Table 4.
Etiologies, “Thwaites system and Lancet consensus scoring system” in 395 adults with subacute/chronic meningitis
| 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 |
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
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
c162 cases of CSF Culture positive for TB Complex, although all 162 cases are definite TBM , we calculated the actual Lancet score
d36 cases of Cryptococcal Meningitis , 3 cases Coccidiosis Meningitis, 2 cases of Histoplasma Meningitis
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
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
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
hUnknown cause of meningitis