Clinical analysis of 246 patients with tuberculous meningitis

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Author:
ZHU Min(Tuberculosis Treatment Center,Integrated Chinese and Western Medicine Hospital of Zhejiang Province,Hangzhou 310003,China)
YIN Liang-sheng(Tuberculosis Treatment Center,Integrated Chinese and Western Medicine Hospital of Zhejiang Province,Hangzhou 310003,China)
LI Feng(Tuberculosis Treatment Center,Integrated Chinese and Western Medicine Hospital of Zhejiang Province,Hangzhou 310003,China)
LIU Jian-ren()
Journal Title:
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
Issue:
Volume 03, Issue 05, 2010
DOI:
10.3760/cma.j.issn.1674-2397.2010.05.005
Key Word:
Tuberculosis,meningeal;Cerebrospinal fluid;Adenosine deaminase

Abstract: Objective To review the clinical and laboratory features of tuberculous meningitis (TBM). Methods The clinical and laboratory data from 246 cases of TBM in Tuberculosis Treatment Center of Integrated Chinese and Western Medicine Hospital of Zhejiang Province from January 1,1999 to December 31,2005 were collected and analyzed with SPSS 15.0 software. Results In 246 TBM patients,203(82.5%)was of basilar meningitis, 170(69. 1%)complicated with pulmonary tuberculosis. Fever,nausea, vomiting and headache were common symptoms in TBM patients. PPD skin tests were positive in 155(63.0%)patients, but only 12(4.9%)were acid-fast bacillus smear-positive in cerebrospinal fluid (CSF). CSF test showed that the white blood cells[(320 - 880)× 106/L], protein(0. 95 - 13.8 g/L)were increased, while glucose(1.53 - 3.2 mmol/L)and chloride content(90 - 111 mmol/L)were decreased. Adenosine deaminase ≥8 U/L was observed in 230(93.5%)patients, and 185(75.2%)patients were tuberculosis antibody positive. Eighty-one(32. 9%)patients showed nodular or annular shadows in cranial CT. After comprehensive therapy, 242(98.4%)patients recovered or improved and no sequela was observed, while 4(1.6%)patients died. Conclusion Early diagnosis of TBM should be based on clinical manifestations, changes of cerebrospinal fluid, imaging examination and PPD test.

  • [1]Quan C,Lu CZ,Qiao J,et al.Comparative evaluation of early diagnosis of tuberculous meningitis by different assays.J Clin Microbiol,2006,44(9):3160-3166.
  • [2]王维治.神经病学.5版.北京:人民卫生出版社,2005:175.
  • [3]王健,柳兴军,张赛.结核性脑膜炎47例临床分析.现代中西医结合杂志,2009,18(16):1894-1895.
  • [4]邱丽蓉.结核性脑膜炎124例分析.中国误诊学杂志,2008,8(18):4440-4441.
  • [5]范永琛,徐勇胜,卢鸣.儿童结核性脑膜炎临床分型分期与早期诊断.中国实用儿科杂志,2009,24(1):17-19.
  • [6]曾丹,于德禄.65例小儿结核性脑膜炎临床死亡分析.临床肺科杂志,2009,14(4):484-485.
  • [7]Sheu JJ,Yuan RY,Yang CC.Predictors for outcome and treatment delay in patients with tuberculous meningitis.Am J Med Sci,2009,338(2):134-139.
  • [8]Lodha R,Kabra SK.Newer diagnostic modalities for tuberculosis.Indian J Pediatr,2004,71(3):221-227.
  • [9]周文琳,田荆芳.结核性脑膜炎389例临床分析及早期诊断的探讨.临床肺科杂志,2009,14(5):626-628.
  • [10]Kashyap RS,Kainthla RP,Mudaliar AV,et al.Cerebrospinal fluid adenosine deaminase activity:a complimentary tool in the early diagnosis of tuberculous meningitis.Cerebrospinal Fluid Res,2006,30:3-5.
  • [11]周大明,彭仕芳.结核性脑膜炎脑脊液多项指标的动态研究.重庆医科大学学报,2009,34(1):105-108.
  • [12]常晓琳,张敏,杨毅宁,等.结核性脑膜炎临床诊断的分析.第四军医大学学报,2009,30(8):704-706.
  • [13]李鹏刚,张伟.结核性脑膜炎364例脑脊液结果分析.中国误诊学杂志,2008,8(15):3668-3669.
  • [14]Chotmongkol V,Teerajetgul Y,Yodwut C.Cerebrospinal fluid adenosine deaminase activity for the diagnosis of tuberculous meningitis in adults.Southeast Asian J Trop Med Public Health,2006,37(5):948-952.
  • [15]李钦云,曹励之.结核性脑膜炎患儿脑脊液腺苷脱氨酶活力的变化.北京医学,2008,30(3):140-143.
  • [16]Kashyap RS,Agarwal NP,Chandak NH,et al.The application of the Mancini technique as a diagnostic test in the CSF of tuberculous meningitis patients.Med Sci Monit,2002,8(6):MT95 -MT98.
  • [17]谈鹰,王庄,王亚仙.结核性脑膜炎患者脑脊液中腺苷脱氨酶的诊断意义及动态变化观察.实用医学杂志,2009,25(3):408-409.
  • [18]Tuon FF,Higashino HR,Lopes MI,et al.Adenosine deaminase and tuberculous meningitis-a systematic review with metaanalysis.Scand J Infect Dis,2010,42(3):198-207.
  • [19]王文科,杨昆胜.检测脑脊液结核抗体对结核性脑膜炎的诊断价值.实用预防医学,2008,15(3):873-874.
  • [20]高阳,于滨,姜云清,等.脑脊液二项指标联合检测对结核性脑膜炎的诊断价值.中围误诊学杂志,2009,9(4):775-776.
  • [21]李向红,田荆芳.小儿结核性脑膜炎64例早期诊断和误诊原因的分析.临床肺科杂志,2009,14(4):486-487.
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