El-Wahab et al reported clinical decision rules for evaluating an HIV-positive patient for meningitis. One rule helps to identify the causative pathogen. The authors are from Alexandria University and Alexandria Fever Hospital in Alexandria, Egypt.
Patient selection: HIV-positive patient with neurological findings
Parameters:
(1) cryptococcal antigen in blood
(2) pale and cold skin
(3) arthralgias
(4) myalgias
(5) cranial nerve involvement
(6) cerebrospinal fluid LDH
(7) outcome
(8) focal neurological deficit
|
Bacterial Parameters
|
Finding
|
Points
|
|
pale and cold skin
|
yes
|
0
|
|
|
no
|
2
|
|
arthralgias
|
yes
|
5
|
|
|
no
|
0
|
|
myalgias
|
yes
|
0
|
|
|
no
|
5
|
|
cranial nerve involvement
|
yes
|
0
|
|
|
no
|
3
|
|
CSF LDH
|
not elevated
|
0
|
|
|
elevated
|
2
|
|
outcome
|
cured
|
0
|
|
|
complicated or died
|
2
|
|
TB Parameters
|
Finding
|
Points
|
|
focal neurological deficit
|
no
|
0
|
|
|
yes
|
2
|
|
cranial nerve involvement
|
no
|
0
|
|
|
yes
|
4
|
|
Cryptococcal Parameter
|
Finding
|
Points
|
|
cryptococcal antigen
|
negative
|
0
|
|
|
positive
|
3
|
|
outcome
|
cured
|
2
|
|
|
not cured
|
0
|
total score for bacterial meningitis =
= SUM(points for all of the bacterial parameters)
total score for TB meningitis =
= SUM(points for the tuberculous parameters)
total score for cryptococcal meningitis =
= SUM(points for the cryptococcal parameters)
Interpretation:
• minimum score: 0
• maximum score for bacterial meningitis: 19
• maximum score for tuberculous meningitis: 6
• maximum score for cryptococcal meningitis: 5
Performance:
• The area under the ROC curve was 0.90 for bacterial, 0.84 for tuberculous and 0.79 for cryptocccal meningitis.
