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Table 1 Diagnostic criteria for classification of definite, probable, possible, and not tuberculous meningitis4

From: Clinical, radiological and laboratory findings in 185 children with tuberculous meningitis at a single centre and relationship with the stage of the disease

  Diagnostic score
Clinical criteria (Maximum category score = 6)
 Symptom duration > 5 days 4
 Systemic symptoms suggestive of TB (one or more of the following): weight loss (or poor weight gain in children), night sweats, or persistent cough > 2 weeks 2
 History of recent (within past year) close contact with an individual with pulmonary TB or a positive TST or IGRA (only in children <10 years of age) 2
 Focal neurological deficit (excluding cranial nerve palsies) 1
 Cranial nerve palsy 1
 Altered consciousness 1
CSF criteria (Maximum category score = 4)
 Clear appearance 1
 Cells: 10–500 per μl 1
 Lymphocytic predominance (>50 %) 1
 Protein concentration > 1 g/L 1
 CSF to plasma glucose ratio < 50 % or an absolute CSF glucose concentration < 2.2 mmol/L 1
Cerebral imaging criteria (Maximum category score = 6)
 Hydrocephalus 1
 Basal meningeal enhancement 2
 Tuberculoma 2
 Infarct 1
 Pre-contrast basal hyperdensity 2
 Evidence of TB elsewhere (Maximum category score = 4)
 Chest radiograph suggestive of active TB: signs of TB = 2; miliary TB = 4 2/4
 CT/ MRI/ ultrasound evidence for TB outside the CNS 2
 AFB identified or M.tuberculosis cultured from another source—ie, sputum, lymph node, gastric washing, urine, blood culture 4
 Positive commercial M.tuberculosis TB NAAT from extra-neural specimen 4
  1. Exclusion of alternative diagnoses: An alternative diagnosis must be confirmed microbiologically (by stain, culture, or NAAT when appropriate), serologically (eg, syphilis), or histopathologically (eg, lymphoma). The list of alternative diagnoses that should be considered, dependent upon age, immune status, and geographical region, include: pyogenic bacterial meningitis, cryptococcal meningitis, syphilitic meningitis, viral meningo-encephalitis, cerebral malaria, parasitic or eosinophilic meningitis (Angiostrongylus cantonesis, Gnathostoma spinigerum, toxocariasis, cysticercosis), cerebral toxoplasmosis and bacterial brain abscess (space-occupying lesion on cerebral imaging)and malignancy (eg, lymphoma) TB tuberculosis, TST tuberculin skin test, IGRA interferon-gamma release assay, NAAT nucleic acid amplification test, AFB acid-fast bacilli