Factors associated to the positive cerebrospinal fuid culture in the tuberculous meningitis

Abstract

-Central nervous system involvement is the most common neurological complication in the course of tuberculosis. The lack of rapid and sensitive tests delays the early diagnosis. Here, we retrospectively reviewed the cerebrospinal fluid (CSF) examination of 30 patients with tuberculous meningitis confirmed by bacteriological tests (culture and/or polymerase chain reaction). The purpose of the present study was to determine the CSF parameters associated to the positive CSF culture for Mycobacterium tuberculosis in tuberculous meningitis. We found higher frequency of positive CSF culture in patients infected with HIV as well in patients with high number of neutrophils and high protein content (characteristic in the early or acute-stage patients), which suggests that the positive culture found in these patients may be associated with the presence of high bacillary load in CSF occurring in these stages.KEY WORDS: tuberculous meningitis, cerebrospinal fluid, HIV, Mycobacterium tuberculosis, culture. Fatores associados à positividade da cultura do líquido cefalorraquidiano na meningite tuberculosaRESUMO -A meningite tuberculosa é a complicação neurológica mais freqüente no curso da tuberculose. Entretanto, a carência de testes rápidos e sensíveis dificulta o diagnóstico precoce, contribuindo para o elevado índice de letalidade desta condição. Na presente análise, é feita revisão dos achados do líquido cefalorraquidiano (LCR) de 30 pacientes com o diagnóstico de meningite tuberculosa confirmado pelo exame bacteriológico. O objetivo do estudo consiste em caracterizar os parâmetros associados à positividade da cultura para Mycobacterium tuberculosis no LCR. Observamos maior freqüência de cultura positiva entre os pacientes infectados pelo HIV e naqueles que apresentam aumento de neutrófilos e da concentração de proteína no LCR. Nossos achados se justificam pelo fato de que na co-infecção com o HIV ocorre maior carga bacilífera em comparação aos pacientes não co-infectados. A presença de neutrofilorraquia e hiperproteinorraquia são marcadores de inflamação aguda, onde se supõe existir também maior concentração de bactérias no LCR.

Neurons Are Host Cells for Mycobacterium tuberculosis

“…Several studies have reported an increase in the prevalence of CNS-TB under conditions of immune suppression, e.g., in HIV-coinfected patients, who often present with low CD4 ϩ T cell counts (49,50). M. tuberculosis bacilli are more likely to be detected in the cerebrospinal fluid (CSF) of immunosuppressed patients (51,52), possibly due to higher levels of bacilli and of dissemination. As a key requirement to control M. tuberculosis bacillus replication (53), low CD4 ϩ T cell counts could predispose such patients to increased levels of CNS bacilli.…”

Validation of Thwaites' Diagnostic Scoring System for the Differential Diagnosis of Tuberculous Meningitis and Bacterial Meningitis

“…Moreover, harsh culture conditions and time-consuming culture operations are major bottlenecks for the early diagnosis of TBM. Although several rapid culture systems such as BACTEC and ESP have been established in recent years, their extensive use in developing countries and underdeveloped regions still remains difficult (11)(12)(13). Therefore, clinical features and routine laboratory examinations remain the chief methods for the differential diagnosis of TBM and BM (14).…”

Identification of Mycobacterium tuberculosis in the cerebrospinal fluid of patients with meningitis using nested PCR

“…Tuberculosis (TB) remains among the leading infectious causes of death in developing nations, with Mycobacterium tuberculosis (M. tuberculosis; MT) as the species responsible for most of these deaths (1,2). According to the World Health Organization (WHO), in 2014, the estimated number of tuberculosis cases was 9 million, including 3.5 million new cases and 1.1 million human immunodeficiency virus (HIV)-positive cases.…”