Diagnostic features of tuberculous meningitis: a cross-sectional study

Abstract

BackgroundTuberculous 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.MethodsAdult 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.Results91 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.ConclusionIn patients with chronic meningitis syndrome, only abnormal CSF was associated with the diagnosis of TBM.

Tuberculous meningitis: presentation, diagnosis and outcome in hiv-infected patients at the douala general hospital, cameroon: a cross sectional study

“…Though these finding were similar to those of some studies [1,2,25] they were less than the over 80% prevalence in other studies [26,27]. This discrepancy could be simply because our patients were more severely immune depressed and patients with low CD4 counts are more likely to present atypically [21]. More so, classical features expected in bacterial meningitis were uncommon in our TBM patients [28] probably because TBM being a sub-acute disease with insidious onset and variable duration of symptoms from a few days to many months [29] there is possibility of symptom modification by previous non-specific treatment as is often the case with many patients we receive in our referral institution.…”

“…As with other forms of TB, the gold standard of diagnosis is isolation of tuberculous bacilli through detection by acid fast staining and/or culture of CSF. Nevertheless, the yield of acid fast staining and culture still remains low [20,21]. This fact could be illustrated in our study where confirmatory diagnosis by bacillary microscopy was in only 1.9% (1/54) of patients, the rest of the diagnosis being presumptive.…”

Tuberculous Meningitis in Patients Living with HIV

“…The gradual onset of symptoms before hospitalization noted in 84% of cases in our study is consistent with that of Luma et al [7]. Atypical CSF result are more common in HIV infected patients, including lower CSF protein, higher glucose levels, lower CSF WCC and even completely normal CSF finding have been reported in 25% to 33% of HIV infected TBM cases [16][17][18][19][20][21][22]. The absence of CSF pleocytosis occur generally in patients with low numbers of lymphocytes in the peripheral blood (CD4 T-cell counts < 50 cells/MI), which may be reflected by a low lymphocytes count in the CSF [7,21].…”

“…Headache was present in 75% in other studies [6,14,15]. This difference could be explaining by lower CD4 count of our patients and patients more severely immune depresses will present unusually [16]. However, our study was distinguished by the frequency of unconsciousness noted in 38% of cases.…”

“…The demonstration of Mycobacterium tuberculosis in CSF is the gold standard for diagnosis; and for drug-susceptibility testing. Though, CSF MT culture is slow and insufficiently sensitive (roughly 60-70%) [3,6,24,25]. This fact could be illustrated in our study where confirmatory diagnosis by culture was in only 20% of patients.…”