The Roles of Thwaites' and Marais' Diagnostic Scoring Indexes and a Clinical Prediction Model in the Diagnosis of Tuberculous Meningitis/Tuberkuloz Menenjit Tanisinda Thwaites ve Marais'in Tani Skor Indeksleri ve Klinik Bir Tahmin Modelinin Rolu

• Published in: Medical journal of Bakirköy Vol. 17; no. 3; p. 221
• Main Authors: Karabela, Semsi Nur, Unlu, Gulten, Senoglu, Sevtap, Unlu, Esra Canbolat, Korkusuz, Ramazan, Yasar, Kadriye Kart
• Format: Journal Article
• Language: English
• Published: Galenos Yayinevi Tic. Ltd 01.09.2021
• Subjects: Diagnosis; Evaluation; Medical tests; Tuberculosis; Turkey
• DOI: 10.4274/BMJ.galenos.2021.73792
• ISSN: 1305-9319

Objective: Tuberculous meningitis (TBM) is the most severe form of extra pulmonary tuberculosis. Bacteriological confirmative tests based on mycobacterial cultures or polymerase chain reaction tests are time-consuming process may not help diagnose every TBM patient. Therefore, practical and easily applicable scoring systems may be helpful in the early diagnosis of TBM and should be applied in the clinical follow-up process. Methods: The features of 20 patients with TBM were retrospectively evaluated according to the Thwaites' diagnostic scoring indexes (TDSI) and Marais' diagnostic scoring indexes (MDSI) beside a clinical prediction model (CPM) in this study. MDSI, CPM, viral, brucellar, and fungal etiologies were excluded by microscopic, serological, and molecular examinations of cerebrospinal fluid (CSF) and blood in all patients. Results: All patients were assessed for TBM according to TDSI (100%). Of these, 5 (25%) were considered probable TBM, and 15 (75%) were possible TBM, according to MDSI. The scores were greater than or equal to 6 in all the cases with TBM by CPM, 13 of which were scored as 9 points (65%). Conclusion: According to the outcomes of our study, the TDSI, MDSI, and CPM assessment methods are easily applicable and helpful techniques for rapid and accurate TBM diagnosis. Keywords: Tuberculosis, tuberculous meningitis, Thwaites, Marais, clinical prediction model Amac: Tuberkuloz menenjit (TBM), ekstrapu Im on er tuberkulozun en ciddi formudur. Mikobakteriyel kultur ve polimeraz zincir reaksiyonu testlerine dayanan bakteriyolojik dogrulama testleri hem zaman alici testlerdir hem de TBM'li her hastanin tanisinda yardimci olmayabilir. Bu yuzden, pratik ve uygulamasi kolay diagnostik skorlama indeksleri TBM'nin erken tanisinda faydali olabilir ve klinik takipte kullanilmalidir. Gerec ve Yontem: Bu calismada 20 TBM hastasinin ozellikleri, klinik tahmin modelinin yani sira Thwaites ve Marais'in diagnostik skorlama indekslerine (TDSI ve MDSI) gore retrospektif olarak degerlendirildi. Tum hastalarda BOS ve kanin mikroskobik, serolojik ve molekuler incelemeleri ile viral, brusellar ve fungal etiyolojiler dislandi. Tartisma: Tum hastalar TDSI'ya gore (%100) TBM olarak degerlendirilirken, sirasiyla 5'i (%25) ve kalan 15'i (%75) MDSI'ye gore olasi TBM ve olasi TBM olarak degerlendirildi. CPM ile TBM olan tum olgularda puanlar 6'dan buyuk veya esit olup, 13'u 9 puan (%65) olarak puanlanmistir. Sonuc: Calismamizin sonuclarina gore TDSI, MDSI ve CPM degerlendirme yontemleri TBM'nin hizli ve dogru teshisi icin uygulanmasi kolay ve kullanisli tekniklerdir. Anahtar Kelimeler: Tuberkuloz, tuberkuloz menenjit, Thwaites, Marais, klinik tahmin modeli