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.
Highlights
Tuberculous meningitis (TBM) is a common central nervous system infection in the Philippines; it is difficult to diagnose as findings are non-specific
This study aimed to determine if the following clinical and laboratory features are associated with a diagnosis of definite TBM in patients with chronic meningitis syndrome: new-onset seizures; focal neurologic deficit; (+) pulmonary tuberculosis (PTB) on chest X-ray; cerebrospinal fluid (CSF) lymphocytic pleocytosis; decreased CSF glucose; increased CSF protein
This study shows that an abnormal CSF profile has a moderate sensitivity and specificity, comparable with more advanced molecular methods such as polymerase chain reaction (PCR), and a definite improvement over the current gold standard of acid fast bacilli (AFB) smear or TB culture
Summary
Tuberculous meningitis (TBM) is a common central nervous system infection in the Philippines; it is difficult to diagnose as findings are non-specific. The yield from acid-fast staining and culture remains to be very low, probably because of the low concentration of bacilli in the cerebrospinal fluid (CSF). The author’s own series of 63 cases had a positive culture yield in only 3 of these [4]. Molecular methods, such as polymerase chain reaction (PCR)-based diagnostic techniques, have begun to be applied in the local setting, but are relatively expensive, and the yield greatly depends on stringent quality control. The search continues for a reliable, accurate, yet performed and inexpensive diagnostic test
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