Reliability and Diagnostic Performance of CT Imaging Criteria in the Diagnosis of Tuberculous Meningitis

The original publication is available at http:// www.plosone.orgPublication of this article was funded by the Stellenbosch University Open Access Fund.Introduction: Abnormalities on CT imaging may contribute to the diagnosis of tuberculous meningitis (TBM). Recently, an expert consensus case definition (CCD) and set of imaging criteria for diagnosing basal meningeal enhancement (BME) have been proposed. This study aimed to evaluate the sensitivity, specificity and reliability of these in a prospective cohort of adult meningitis patients. Methods: Initial diagnoses were based on the CCD, classifying patients into: ‘Definite TBM’ (microbiological confirmation), ‘Probable TBM’ (diagnostic score $10), ‘Possible TBM’ (diagnostic score 6–9), ‘Not TBM’ (confirmation of an alternative diagnosis) or ‘Uncertain’ (diagnostic score of ,6). CT images were evaluated independently on two occasions by four experienced reviewers. Intra-rater and inter-rater agreement were calculated using the kappa statistic. Sensitivities and specificities were calculated using both ‘Definite TBM’ and either ‘Definite TBM’ or ‘Probable TBM’ as gold standards. Results: CT scan criteria for BME had good intra-rater agreement (k range 0.35–0.78) and fair to moderate inter-rater agreement (k range 0.20–0.52). Intra- and inter-rater agreement on the CCD components were good to fair (k = ranges 0.47–0.81 and 0.21–0.63). Using ‘Definite TBM’ as a gold standard, the criteria for BME were very specific (61.5%–100%), but insensitive (5.9%–29.4%). Similarly, the imaging components of the CCD were highly specific (69.2–100%) but lacked sensitivity (0–56.7%). Similar values were found when using ‘Definite TBM’ or ‘Probable TBM’ as a gold standard. Discussion: The fair to moderate inter-rater agreement and poor sensitivities of the criteria for BME suggest that little reliance should be placed in these features in isolation. While the presence of the CCD criteria of acute infarction or tuberculoma(s) appears useful as rule-in criteria, their absence is of little help in excluding TBM. The CCD and criteria for BME, as well as any new criteria, need to be standardized and validated in prospective cohort studies.Funding: KB received funding from the Discovery Foundation (Academic Fellowship Award; http://www.discovery.co.za/portal/loggedout-individual/discoverycommunity- about), College of Neurology of South Africa (K.M. Browse Award; http://www.collegemedsa.ac.za/Default.aspx ) and the University of Stellenbosch. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Publisher's versio

Modes of sedimentation and glaciological aspects of the Permo-Carboniferous Dwyka Group in the Elandsvlei - Elandsdrif Area, South Africa

NatuurwetenskappeAardwetenskappePlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]

A 17-Element condont apparatus from the Soom Shale Lagerst�tte ( Upper Ordovovician), South Africa

Please help populate SUNScholar with the full text of SU research output. Also - should you need this item urgently, please send us the details and we will try to get hold of the full text as quick possible. E-mail to [email protected]. Thank you.Journal Articles (subsidised)NatuurwetenskappeAardwetenskapp

The earliest myodocopes: ostracodes from the late Ordovician Soom Shale Lagerstatte of South Africa

The late Ordovician Soom Shale Lagerstätte of South Africa has yielded Myodoprimigenia fistuca n. gen. and n. sp., the earliest and only known Ordovician occurrence of myodocopes, one of the major groups of ostracodes. M. fistuca is a likely sister group of the Upper Silurian 'cypridinid' myodocopes and allied forms. It had a thin, lightly mineralized and flexible shell with microstructures resulting from in vivo calcification processes. It probably fed on cephalopod carrion, thus extending evidence for a carnivorous scavenging lifestyle in ostracodes back by 200 Ma. The species was probably nektobenthic and thus consistent with the notion that the origin of the late Silurian pelagic myodocopes - and therefore of pelagic ostracodes - is to be charted in a benthic to pelagic ecological shift in the group

Late Ordovician(Hirnanation) scolecodont clusters from the Soom Shale Lagerst�tte, South Africa

NatuurwetenskappeAardwetenskappePlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]

Eolian input into the Late Ordovician postglacial Soom Shale, South Africa

NatuurwetenskappeAardwetenskappePlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]