Application of Thwaites’ Score in Central Nervous System Infection in an Immunocompetent Patient: Case Series

Patients with infection in the central nervous system can deteriorate rapidly, so an empirical approach needs to be performed promptly with relevant supporting data that can be produced as early as possible. Decision-making in such cases can use scoring systems such as Thwaites diagnostic score. However, this requires analysis of cerebrospinal fluid, and this is not a commonly performed workup among patients in Jambi. To illustrate the role of routine cerebrospinal fluid analysis, including how the Thwaites scoring system is implemented. Patients who present with the clinical presentation of suspected intracranial infection undergo the lumbar puncture procedure, and other supporting diagnostic procedures were performed where applicable. Results are then summarized and Thwaites score is calculated. Three patients are presented in this case series, and the Thwaites score for two patients were below 4, indicating that tuberculous meningitis is more probable. The score for the third patient was +7, which indicated that bacterial meningitis is more probable. Routine cerebrospinal fluid analysis should be performed as the minimum supporting diagnostic for patients with suspected central nervous system infection, unless contraindications are present. Scoring systems such as Thwaites’ score can then be applied to begin the most appropriate empirical treatment as early as possible.