Differential diagnosis of tuberculous meningitis and other meningitis

Abstract

Objective To understand the clinical characteristics of tuberculosis meningitis, and the differential diagnosis features with other types of meningitis such as viral meningitis, cryptococcal meningitis, purulent meningitis, so as to improve the recovery rate of this disease. Methods There were 45 patients with tuberculosis meningitis, 20 patients with viral meningitis, 15 patients with cryptococcal meningitis and 15 patients with purulent meningitis in Zhejiang Provincial People's Hospital from January 2013 to December 2015 collected in the study. The clinical features of tuberculosis meningitis were compared with those of other three types of meningitis. Results Tuberculosis meningitis patients were commonly complicated with pulmonary tuberculosis and other tuberculosis (29 cases, 64.4%) ; the main underlying diseases were AIDS, diabetes and hypertension; the onset of tuberculosis meningitis was diverse, but usually with sub-acute and chronic symptoms [26 cases (57.8%) and 11 cases (24.4%) ]. The main early symptoms of tuberculosis meningitis were fever (45 cases, 100%) , headache (29 cases, 64.4%) , nausea and vomiting (27 cases, 60.0%) , followed by the damage of central nerve system with the disease progress. The cerebrospinal fluid had characteristic changes with an increased adenosine deaminase (ADA) of (6.67±5.32) U/L. The cerebral parenchyma damage was the most common feature by neuroimaging (16 cases, 35.6%) . Conclusions Early diagnosis of tuberculosis meningitis should be combined with clinical evaluation, cerebrospinal fluid laboratory test and graphic assessment, in which cerebrospinal fluid, head CT or MRI are of great value. Key words: Tuberculosis, meningeal; Clinical features; Differential diagnosis