Bibliographic record
Abstract
Uncertainty and doubt dominate all aspects of tuberculous meningitis (TBM).The variable natural history and accompanying clinical features of TBM hinders the diagnosis.Ziehl-Neelsen staining lacks sensitivity and culture results are often insuYciently timely to aid clinical judgement.New rapid diagnostic methods are incompletely evaluated, and many are not suitable for laboratories in low income countries.The duration of chemotherapy for TBM is unclear and the benefits of adjuvant corticosteroids remain in doubt.The only uncomfortable certainties lie in the fatal consequences of missed diagnoses and delayed treatment.This review will discuss the current uncertainties surrounding TBM.More attention will be given to diagnosis and management, as these areas have a direct bearing on patient outcome. EpidemiologyAbout 2000 million people in the world today are infected with tuberculosis, 1 but only 10% develop clinical disease.Why some people develop clinical disease remains unclear.The reasons are likely to be multifactorial: inherent not just to the individual person, but to their given population and environment.Before HIV the most important determinant for the development of TBM was age.In populations with high TB prevalence TBM diVers from pulmonary, and other extrapulmonary tuberculosis, in that the peak age is from 0-4 years. 2 In populations with lower TB prevalence, most cases of TBM are in adults.Risk factors identified for these people are alcoholism, diabetes mellitus, malignancy, and recent corticosteroid use.[3][4][5] Coinfection with HIV now dwarfs these risk factors.HIV increases the lifetime risk of developing clinical TB postinfection to 1 in 3. 6 HIV also predisposes to the development of extrapulmonary TB, and in particular TBM, 7 a risk which increases as the CD4 count declines.8 The disease constitutes either reactivation of latent infection, or new infection.Evidence from DNA fingerprinting of strains using restriction fragment length polymorphism suggests that in the United States up to 40% of new disease in both HIV positive and non-HIV patients is due to recent infection.9 10 The extent to which a person's genetic constitution eVects resistance or susceptibility to
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".