The Tryptophane Test and the Blood Picture of Tuberculous Meningitis, of Purulent Meningitis and of Encephalitis

Abstract

The tryptophane test was examined in 33 samples of cerebrospinal fluids of 16 cases of tuberculous meningitis. The bacillus was identified in these cases either by staining or by culture. The test was further tried in 12 fluids of 7 cases of active tuberculosis and in 30 fluids of 22 cases of other various diseases. Moreover, the blood picture of all the 16 cases of tuberculous meningitis, of 8 cases of purulent meningitis and of 6 cases of encephalitis was examined. Among 7 cases of active tuberculosis there were 2 cases that turned out clinically to be tuberculous meningitis, though the bacillus was not identified. Of the 16 cases of tuberculous meningitis, 15 cases (94%) were positive to the tryptophane test. 7 cases of active tuberculosis, including 2 highly probable cases of tuberculous meningitis, showed a negative tryptophane test. If the above mentioned 2 cases of active tuberculosis with highly probable meningitis were counted together, the positive result would be 83% or 15 cases out of 18. The positive tryptophane test and the microscopical identification of the tubercle bacillus tended to be obtainable from about 2 weeks on before death, but 'not in a very early stage. All the cases of purulent meningitis gave a false but distinguish-able positive reaction. The positive test was obtained from a case of serous meningitis and a case of encephalitis. So the tryptophane test will not be said to be specific for tuberculous meningitis, but it is characteristic enough, as far as transparent and colourless fluid is concerned. The blood picture of tuberculous meningitis was generally as follows:-marked leucocytosis due to neutrophilia, lymphopenia, an-eosinophilia, monocytosis, moderately accelerated sedimentation rate, and the Arneth nuclear shift to the left in slight degree. Purulent meningitis and encephalitis showed almost the same feature as that of tuberculous meningitis, there being only a slight difference in the grade of change, so the essential difference of blood picture between these diseases was not seen.