{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T02:13:03Z","timestamp":1793931183249,"version":"4.8.0"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,3,8]],"date-time":"2018-03-08T00:00:00Z","timestamp":1520467200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Diagnosis of tuberculous meningitis (<jats:styled-content style=\"fixed-case\">TM<\/jats:styled-content>) is a challenge in countries with a high burden of the disease and constrained resources and clinical prediction rules (<jats:styled-content style=\"fixed-case\">CPR<\/jats:styled-content>s) could be of assistance. We aimed at developing a <jats:styled-content style=\"fixed-case\">CPR<\/jats:styled-content> for diagnosis of <jats:styled-content style=\"fixed-case\">TM<\/jats:styled-content> in a Latin American setting with high tuberculosis incidence and a concentrated <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> epidemic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We enrolled adult patients with clinical suspicion of <jats:styled-content style=\"fixed-case\">TM<\/jats:styled-content> attending two hospitals in Lima, Peru. We obtained information on potential anamnestic, clinical and laboratory predictive findings that are easy to collect and promptly available. We independently diagnosed <jats:styled-content style=\"fixed-case\">TM<\/jats:styled-content> according to a composite reference standard that included a series of microbiological tests. We performed bivariate analysis and constructed a logistic regression model to select the predictive findings associated with <jats:styled-content style=\"fixed-case\">TM<\/jats:styled-content>. With the selected predictors included in the model, we developed a score\u2010based <jats:styled-content style=\"fixed-case\">CPR<\/jats:styled-content>. We assessed its internal validity and diagnostic performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 155 analysed patients, 59 (38%) had <jats:styled-content style=\"fixed-case\">TM<\/jats:styled-content>. The <jats:styled-content style=\"fixed-case\">CPR<\/jats:styled-content> we derived includes three predictors: cough for 14 days or more, 10\u2013500 cells in <jats:styled-content style=\"fixed-case\">CSF<\/jats:styled-content> and adenosine deaminase \u2265 6 U\/l in <jats:styled-content style=\"fixed-case\">CSF<\/jats:styled-content>. It classifies patients into high\u2010, moderate\u2010 or low\u2010score groups and has an overall area under the <jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content> curve of 0.87. 59% of patients were assigned to either the high\u2010 or the low\u2010score group, permitting prompt decision\u2010making. In patients in the high\u2010score group, it attains a positive likelihood ratio for <jats:styled-content style=\"fixed-case\">TM<\/jats:styled-content> of 10.6 and in patients with low scores, a negative likelihood ratio of 0.10. Bootstrap analysis indicated high internal validity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This <jats:styled-content style=\"fixed-case\">CPR<\/jats:styled-content> could support decision\u2010making in patients with clinical suspicion of <jats:styled-content style=\"fixed-case\">TM<\/jats:styled-content>. External validation and further assessment of its clinical impact are necessary before application in other settings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13041","type":"journal-article","created":{"date-parts":[[2018,2,15]],"date-time":"2018-02-15T13:43:40Z","timestamp":1518702220000},"page":"367-374","source":"Crossref","is-referenced-by-count":10,"title":["Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru"],"prefix":"10.1111","volume":"23","author":[{"given":"Lely","family":"Solari","sequence":"first","affiliation":[{"name":"Unit of General Epidemiology and Disease Control Institute of Tropical Medicine of Antwerp Antwerp Belgium"},{"name":"Escuela de Medicina Universidad Peruana de Ciencias Aplicadas Lima Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alonso","family":"Soto","sequence":"additional","affiliation":[{"name":"Escuela de Medicina Universidad Peruana de Ciencias Aplicadas Lima Peru"},{"name":"Departamento de Medicina Hospital Nacional Hip\u00f3lito Unanue Lima Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Van der Stuyft","sequence":"additional","affiliation":[{"name":"Unit of General Epidemiology and Disease Control Institute of Tropical Medicine of Antwerp Antwerp Belgium"},{"name":"Department of Public Health Gent University Gent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,3,8]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"CD002244","article-title":"Corticosteroids for managing tuberculous meningitis","volume":"1","author":"Prasad K","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_3_1","first-page":"1","article-title":"Factors associated with delayed diagnosis of tuberculosis in hospitalized patients in a high TB and HIV burden setting: a cross\u2010sectional study","volume":"12","author":"Silva DR","year":"2012","journal-title":"BMC Infect Dis"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1023673532656"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.05434-11"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-006-0215-y"},{"key":"e_1_2_6_7_1","first-page":"557","article-title":"Cerebrospinal fluid C reactive protein and adenosine deaminase in meningitis in adults","volume":"59","author":"Belagavi AC","year":"2011","journal-title":"J Assoc Physicians India"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365540903428158"},{"key":"e_1_2_6_9_1","first-page":"1382","article-title":"Diagnostic value of adenosine deaminase in cerebrospinal fluid for tuberculous meningitis: a meta\u2010analysis","volume":"14","author":"Xu HB","year":"2010","journal-title":"Int J Tuberc Lung Dis"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)11318-3"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2006.01.027"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365540902721384"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1159\/000333808"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1159\/000084631"},{"key":"e_1_2_6_15_1","doi-asserted-by":"crossref","first-page":"555","DOI":"10.4269\/ajtmh.2007.77.555","article-title":"Validation of a diagnostic algorithm for adult tuberculous meningitis","volume":"77","author":"Torok ME","year":"2007","journal-title":"Am J Trop Med Hyg"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2008.02109.x"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2011.12.033"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2010.02565.x"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.11.0687"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/1756-0500-5-49"},{"key":"e_1_2_6_21_1","unstructured":"WHO.Global Tuberculosis Report 2015. 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