Infect Chemother.  2021 Mar;53(1):53-62. 10.3947/ic.2020.0104.

Machine-Learning-Based Approach to Differential Diagnosis in Tuberculous and Viral Meningitis

  • 1Big Data Engineering department, Soonchunhyang University, Asan, Korea
  • 2R&D department, PharmCADD, Busan, Korea
  • 3Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 4Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
  • 5Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
  • 6Division of Infectious Diseases, Department of Internal Medicine, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
  • 7Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
  • 8Division of Infectious Diseases, Dongguk University Ilsan Hospital, Goyang, Korea
  • 9Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
  • 10Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea


Tuberculous meningitis (TBM) is the most severe form of tuberculosis, but differentiating between the diagnosis of TBM and viral meningitis (VM) is difficult. Thus, we have developed machine-learning modules for differentiating TBM from VM. Material and Methods: For the training data, confirmed or probable TBM and confirmed VM cases were retrospectively collected from five teaching hospitals in Korea between January 2000 - July 2018. Various machine-learning algorithms were used for training. The machinelearning algorithms were tested by the leave-one-out cross-validation. Four residents and two infectious disease specialists were tested using the summarized medical information.
The training study comprised data from 60 patients with confirmed or probable TBM and 143 patients with confirmed VM. Older age, longer symptom duration before the visit, lower serum sodium, lower cerebrospinal fluid (CSF) glucose, higher CSF protein, and CSF adenosine deaminase were found in the TBM patients. Among the various machinelearning algorithms, the area under the curve (AUC) of the receiver operating characteristics of artificial neural network (ANN) with ImperativeImputer for matrix completion (0.85; 95% confidence interval 0.79 - 0.89) was found to be the highest. The AUC of the ANN model was statistically higher than those of all the residents (range 0.67 - 0.72, P <0.001) and an infectious disease specialist (AUC 0.76; P = 0.03).
The machine-learning techniques may play a role in differentiating between TBM and VM. Specifically, the ANN model seems to have better diagnostic performance than the non-expert clinician.


Tuberculosis; Virus; Meningitis; Machine learning; Diagnosis
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