Tuberculous Meningitis in PD Patients

Abstract

Tuberculous meningitis is a very rare, but serious extrapulmonary complication of mycobacterial infections in immuno compromised patients, such as peritoneal dialysis recipients. A retrospective study of 455 peritoneal dialysis patients was made to determine the incidence and understand the demographic features of patients that lead to the development of Tuberculous meningitis on the basis of CSF for cell count, routine, ADA estimation, ZN Stain, culture&PCR. Between Jan 2000 and March 2017 4.39% patients of the total patients studied had Tuberculous meningitis. CSF smear was positive for AFB in 22.2% patients, CSF culture isolated AFB in 52.8% patients, PCR was found positive in 36.1% cases, and 4.39% patients were found to be having CSF ADA above cut off value. Pearson correlation indicates that lymphocyte counts and protein levels both increase as ADA increases, however sugar decreases as ADA, lymphocyte counts and protein increase in Tuberculous meningitis patients which is also proven by regression analysis. Outcome analysis revealed 30% mortality rate in diagnosed Tuberculous meningitis cases while maximum loss of life (36.36%) was seen in diabetic patients. It is concluded that the incidence of Tuberculous meningitis in peritoneal dialysis recipients was 4.39% and mortality rate was 30%. The rapid diagnosis of Tubercular meningitis is fundamental to clinical outcome. The present study clearly states that ADA is a rapid and fairly specific method for the diagnosis of Tuberculous meningitis. The early diagnosis and treatment help in achieving an improved outcome for PD patients. However, other techniques like AFB smear, PCR for M.tuberculosis and rapid culture would be required for confirmation of the diagnosis.