Anwar et al reported criteria for tuberculous meningitis in children based on modifications of the Kenneth Jones criteria. The authors are from Bahawal Victoria Hospital in Bahawalpur, Pakistan.
Patient selection: 7 months to 7 years old in a developing country with meningitis
Parameters:
(1) age in years
(2) contact with a patient with tuberculosis
(3) BCG scar
(4) history of measles or whooping cough
(5) immunosuppression or immunocompromised status
(6) PCM III (protein calorie malnutrition)
(7) physical examination
(8) radiology findings (chest X-ray findings)
(9) tuberculin tests
(10) granuloma
(11) sputum for acid fast bacilli (AFB)
|
Parameter |
Finding |
Points |
|
age in yeaars |
< 2 years |
1 |
|
|
>= 2 years |
0 |
|
TB contact |
none |
0 |
|
|
sputum negative TB |
1 |
|
|
sputum positive TB |
3 |
|
BCG scar |
present or not vaccinated |
0 |
|
|
absent and vaccinated |
1 |
|
measles or whooping cough |
none |
0 |
|
|
within 3 months |
2 |
|
|
3-6 months |
1 |
|
|
> 6 months |
0 |
|
immunosuppression or immunocompromised |
no |
0 |
|
|
yes |
1 |
|
PCM III |
no |
0 |
|
|
yes |
1 |
|
|
not improving |
3 |
|
physical exam |
not suggestive of TB |
0 |
|
|
suggestive of TB |
2 |
|
|
strongly suggestive |
4 |
|
radiology findings |
negative |
0 |
|
|
nonspecific with consolidation not responding to antibiotics |
1 |
|
|
strongly suggestive of TB (paratracheal or mediastinal adenitis; miliary mottling |
2 |
|
tuberculin test in BCG vaccinated patient |
< 5 mm |
0 |
|
|
5 to 10 mm |
1 |
|
|
> 10 mm |
3 |
|
granuloma |
specific for TB |
5 |
|
|
none or not specific |
0 |
|
AFB |
negative |
0 |
|
|
positive |
5 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 30
|
Total Score |
Risk of Tuberculosis |
|
<= 2 |
unlikely |
|
3 or 4 |
TB uncertain (observe) |
|
5 or 6 |
TB probable |
|
>= 7 |
TB present |
Specialty: Infectious Diseases
