Cohen et al reported a tool for distinguishing between cryptococcal and tubercular meningitis in an HIV-Positive Patient in Africa. This can be used by medical resources are limited. The authors are from University of Malawi, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University Clinic Heidelberg and VU Medical Center Amsterdam.
Patient selection: HIV-positive
Parameters:
(1) CSF WBC count per microliter
(2) neck stiffness
(3) CSF opening pressure in mm H2O
Parameter
Finding
Points
CSF WBC count
<= 13 per µL
0
> 13 pr µL
1
neck stiffness
no
0
yes
1
opening pressure
< 310 mm H2O
1
>= 310 mm H2O
0
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• A patient with a score >=1 is diagnosed with tuberculous meningitis.
• A pateint with a score =0 is diagnosed with cryptococcal meningitis.
Performance:
• The area under the ROC curve is 0.87.
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