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Diagnostic features of tuberculous meningitis: a cross-sectional study

Pasco PM - BMC Res Notes (2012)

Bottom Line: Tuberculous meningitis (TBM) is a common central nervous system infection in the Philippines; however it is difficult to diagnose as findings are non-specific.Logistic regression was done to determine which were associated with a diagnosis of TBM. 91 patients were included.Using the gold standard criteria mentioned above, 44 had definite TBM; but if subsequent clinical course and response to anti-Koch's therapy are considered, 68 had a final diagnosis of TBM.

Affiliation: Dept of Neurosciences, UP-PGH Medical Center, Taft Ave, Manila, Philippines. pmdpasco@post.upm.edu.ph.

ABSTRACT

Background: Tuberculous meningitis (TBM) is a common central nervous system infection in the Philippines; however it is difficult to diagnose as findings are non-specific. Hence we decided to determine if, among patients with chronic meningitis syndrome, the following are associated with the diagnosis: new-onset seizures; focal neurologic deficit; pulmonary tuberculosis (PTB) on chest X-ray; cerebrospinal fluid (CSF) pleocytosis with lymphocytic predominance; decreased CSF glucose; increased CSF protein.

Methods: Adult patients with suspected TBM were enrolled after informed consent was obtained. Baseline physical examination and diagnostic tests including CT scan of the head with contrast and CSF analysis for acid fast bacilli (AFB) smear, TB culture and cryptococcal antigen detection were done and results collected. Definite TBM was defined as positive AFB smear or positive TB culture or positive basal meningeal enhancement on CT contrast study. Logistic regression was done to determine which were associated with a diagnosis of TBM.

Results: 91 patients were included. Using the gold standard criteria mentioned above, 44 had definite TBM; but if subsequent clinical course and response to anti-Koch's therapy are considered, 68 had a final diagnosis of TBM. After logistic regression was performed, only abnormal CSF (the combination of CSF pleocytosis with lymphocytic predominance, decreased CSF glucose, and increased CSF protein) was associated with the diagnosis of TBM.

Conclusion: In patients with chronic meningitis syndrome, only abnormal CSF was associated with the diagnosis of TBM.

CT scan of head showing basal meningeal enhancement on contrast study. Arrow points to a tuberculoma.
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Figure 2: CT scan of head showing basal meningeal enhancement on contrast study. Arrow points to a tuberculoma.

Mentions: a. Definite Tuberculous meningitis (TBM): Any patient whose cerebrospinal fluid (CSF) is positive for AFB smear or positive for TB culture or with basal meningeal enhancement on CT head contrast study (Figure 2).

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Diagnostic features of tuberculous meningitis: a cross-sectional study

Pasco PM - BMC Res Notes (2012)

CT scan of head showing basal meningeal enhancement on contrast study. Arrow points to a tuberculoma.
© Copyright Policy - open-access
Figure 2: CT scan of head showing basal meningeal enhancement on contrast study. Arrow points to a tuberculoma.
Mentions: a. Definite Tuberculous meningitis (TBM): Any patient whose cerebrospinal fluid (CSF) is positive for AFB smear or positive for TB culture or with basal meningeal enhancement on CT head contrast study (Figure 2).

Bottom Line: Tuberculous meningitis (TBM) is a common central nervous system infection in the Philippines; however it is difficult to diagnose as findings are non-specific.Logistic regression was done to determine which were associated with a diagnosis of TBM. 91 patients were included.Using the gold standard criteria mentioned above, 44 had definite TBM; but if subsequent clinical course and response to anti-Koch's therapy are considered, 68 had a final diagnosis of TBM.

Affiliation: Dept of Neurosciences, UP-PGH Medical Center, Taft Ave, Manila, Philippines. pmdpasco@post.upm.edu.ph.

ABSTRACT

Background: Tuberculous meningitis (TBM) is a common central nervous system infection in the Philippines; however it is difficult to diagnose as findings are non-specific. Hence we decided to determine if, among patients with chronic meningitis syndrome, the following are associated with the diagnosis: new-onset seizures; focal neurologic deficit; pulmonary tuberculosis (PTB) on chest X-ray; cerebrospinal fluid (CSF) pleocytosis with lymphocytic predominance; decreased CSF glucose; increased CSF protein.

Methods: Adult patients with suspected TBM were enrolled after informed consent was obtained. Baseline physical examination and diagnostic tests including CT scan of the head with contrast and CSF analysis for acid fast bacilli (AFB) smear, TB culture and cryptococcal antigen detection were done and results collected. Definite TBM was defined as positive AFB smear or positive TB culture or positive basal meningeal enhancement on CT contrast study. Logistic regression was done to determine which were associated with a diagnosis of TBM.

Results: 91 patients were included. Using the gold standard criteria mentioned above, 44 had definite TBM; but if subsequent clinical course and response to anti-Koch's therapy are considered, 68 had a final diagnosis of TBM. After logistic regression was performed, only abnormal CSF (the combination of CSF pleocytosis with lymphocytic predominance, decreased CSF glucose, and increased CSF protein) was associated with the diagnosis of TBM.

Conclusion: In patients with chronic meningitis syndrome, only abnormal CSF was associated with the diagnosis of TBM.

View Similar Images In: Results  - Collection
View Article: PubMed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3282639&rFormat=json&query=null&req=5