{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:11:04Z","timestamp":1772169064726,"version":"3.50.1"},"reference-count":36,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2020,1,23]],"date-time":"2020-01-23T00:00:00Z","timestamp":1579737600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/R007942\/1"],"award-info":[{"award-number":["MR\/R007942\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002992","name":"Department for International Development, UK Government","doi-asserted-by":"publisher","award":["MR\/R007942\/1"],"award-info":[{"award-number":["MR\/R007942\/1"]}],"id":[{"id":"10.13039\/501100002992","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns4:p>\n                    Tuberculous meningitis (TBM) is the most devastating form of tuberculosis (TB) but diagnosis is difficult and delays in initiating therapy increase mortality. All currently available tests are imperfect; culture of\n                    <ns4:italic>Mycobacterium tuberculosis<\/ns4:italic>\n                    from the cerebrospinal fluid (CSF) is considered the most accurate test but is often negative, even when disease is present, and takes too long to be useful for immediate decision making. Rapid tests that are frequently used are conventional Ziehl\u2013Neelsen staining and nucleic acid amplification tests such as Xpert MTB\/RIF and Xpert MTB\/RIF Ultra. While positive results will often confirm the diagnosis, negative tests frequently provide insufficient evidence to withhold therapy. The conventional diagnostic approach is to determine the probability of TBM using experience and intuition, based on prevalence of TB, history, examination, analysis of basic blood and CSF parameters, imaging, and rapid test results. Treatment decisions may therefore be both variable and inaccurate, depend on the experience of the clinician, and requests for tests may be inappropriate. In this article we discuss the use of Bayes\u2019 theorem and the threshold model of decision making as ways to improve testing and treatment decisions in TBM. Bayes\u2019 theorem describes the process of converting the pre-test probability of disease to the post-test probability based on test results and the threshold model guides clinicians to make rational test and treatment decisions. We discuss the advantages and limitations of using these methods and suggest that new diagnostic strategies should ultimately be tested in randomised trials.\n                  <\/ns4:p>","DOI":"10.12688\/wellcomeopenres.15611.1","type":"journal-article","created":{"date-parts":[[2020,1,23]],"date-time":"2020-01-23T11:45:06Z","timestamp":1579779906000},"page":"11","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Decision-making in the diagnosis of tuberculous meningitis"],"prefix":"10.12688","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5676-8081","authenticated-orcid":false,"given":"Tom H.","family":"Boyles","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7183-4895","authenticated-orcid":false,"given":"Lutgarde","family":"Lynen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2296-2302","authenticated-orcid":false,"given":"James A.","family":"Seddon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Tuberculous Meningitis International Research Consortium","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2020,1,23]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"581-598","DOI":"10.1038\/nrneurol.2017.120","article-title":"Tuberculous meningitis.","volume":"13","author":"R Wilkinson","year":"2017","journal-title":"Nat Rev 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Dowdy, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 17 Aug 2020, version 1, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/5-11\/v1#referee-response-39828","order":0,"name":"referee-response-39828","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.17101.r40094, James J.C. Nuttall, Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital and Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa, 14 Sep 2020, version 1, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/5-11\/v1#referee-response-40094","order":1,"name":"referee-response-40094","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by the Wellcome Trust through funding to the Tuberculous Meningitis International Research Consortium.\n\nJAS is supported by a Clinician Scientist Fellowship jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC\/DFID Concordat agreement [MR\/R007942\/1]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}