Approach to the diagnosis and management of tuberculous meningitis

Sinner, Scott W.; Tunkel, Allan R.

doi:10.1007/s11908-002-0025-z

Cited by 13 publications

(7 citation statements)

References 41 publications

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“…Examination of cerebrospinal fl uid (CSF) is an important diagnostic tool. Isolation of a microorganism from a CSF culture is essential in the diagnosis, however, practically, this is impossible for each case [3] . Mortality rates are approximately 25-30% in acquired bacterial meningitis despite appropriate antibiotic therapy [4] .…”

Section: Introductionmentioning

confidence: 99%

Thwaites’ Diagnostic Scoring and the Prediction of Tuberculous Meningitis

Sünbül¹,

Atilla²,

Esen³

et al. 2005

Med Princ Pract

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Objective: This study was conducted to investigate the applicability of Thwaites’ diagnostic criteria in order to differentiate tuberculous from bacterial meningitis. Material and Methods: The study was done retrospectively in HIV-negative patients (n = 126) with meningitis. Of the 126 patients, 103 had bacterial meningitis and 23 patients had tuberculous meningitis. The diagnosis was confirmed microbiologically in 59 and 12 patients with bacterial and tuberculous meningitis, respectively. The prediction of tuberculous meningitis was determined by Thwaites’ diagnostic scoring using parameters such as age, history of illness, white blood cell count, total cerebrospinal fluid (CSF) white cell count and the percent of neutrophils in CSF. The diagnostic value of the model was assessed by calculating the area under the receiver operating characteristic (ROC) curves. Results: The sensitivity and the specificity of Thwaites’ diagnostic scoring were 95.6% (22/23) and 70.8% (73/103), respectively. In microbiologically proven cases the sensitivity and the specificity were 91.7% (11/12), 79.7% (57/59), respectively. The area under the ROC curve value for the diagnostic scoring was 0.92. Conclusions: Thwaites’ diagnostic score was found to be helpful in differential diagnosis of tuberculous meningitis, however, the usefulness of diagnostic scoring should be validated in large series especially in patients with viral meningitis and low CSF glucose levels.

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Section: Introductionmentioning

confidence: 99%

Thwaites’ Diagnostic Scoring and the Prediction of Tuberculous Meningitis

Sünbül¹,

Atilla²,

Esen³

et al. 2005

Med Princ Pract

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“…Acellular CSF has been reported in the elderly and in patients with HIV-co-infection. [2,11,13,19] Bacteriological diagnosis, demonstration of acid-fast bacilli (AFB) of M. tuberculosis by Ziehl-Neelsen stain (sensitivity, 25%) and culture (sensitivity, 18%-83%) is highly specific (100%). [13] In the Vietnam study, volume of CSF, duration of symptoms, CSF neutrophil count, lactate and glucose were all independently associated with bacteriological confirmation.…”

Section: Laboratory Diagnosismentioning

confidence: 99%

Tuberculous meningitis: The challenges

Murthy¹

2010

Neurol India

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Tuberculous meningitis (TBM) is a serious meningitic infection commonly found to occur in the developing countries endemic to tuberculosis. Based on the clinical features alone, the diagnosis of TBM can neither be made nor excluded with certainty. Unfortunately there is still no single diagnostic method that is both sufficiently rapid and sensitive. Most factors found to correlate with poor outcome can be directly traced to the stage of the disease at the time of diagnosis. The only way to reduce the mortality and morbidity is by early diagnosis and timely recognition of complications and institution of the appropriate treatment strategies.

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“…Tüberkülöz menenjitin klinik belirti ve bulguları oldukça değişkendir. Hastalık prodrom döneminde halsizlik, baş ağrısı, hafi f ateşle başlar; sonra 2-3 hafta içinde uzamış baş ağrısı, kusma, ateş, konfüzyon, meningismus ve fokal nörolojik belirtilerle sürer (2,10,26). Olgumuzda baş ağrısı, bulantı, kusma ve bilinç bulanıklığı vardı.…”

Section: İrdelemeunclassified

Tuberculous Meningitis during Pregnancy in a Patient Treated for Infertility: A Case Report

Demir¹,

Özçimen²,

Ural³

2010

Klimik Dergisi

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ÖzetTüberküloz önemli bir halk sağlığı problemidir. HIV endemisine bağlı olarak dünya üzerindeki insidansı son 10 yılda artış göster-miştir. Tüberküloz tüm organ ve dokuları tutabilir. Tutulan sisteme göre çok farklı klinik tablolarla karşımıza çıkabilir. Bu nedenle sıklıkla atlanabilir ve buna bağlı morbidite ve mortalitesi artar. Bu makalede yedi yıldır infertilite nedeniyle takip edilen hastada, gebeliğe bağlı immünosüpresyon sonrası gelişen tüberkülöz menenjit olgusu sunulmuştur. Klimik Dergisi 2010; 23(2): 73-5.Anahtar Sözcükler: İnfertilite, ekstrapulmoner tüberküloz, tü-berkülöz menenjit. AbstractTuberculosis is an important public health problem. Its worldwide incidence has increased in the last decade and is related to endemic HIV infection. Tuberculosis can affect all tissues and organs. The clinical spectrum of the disease is variable depending on the affected system, so it may be misdiagnosed, resulting in increased mortality and morbidity. In this article, a patient who suffered from tuberculous meningitis following immunosuppression related to pregnancy after a 7-year infertility treatment was presented. Klimik Dergisi 2010; 23(2): 73-5.Key Words: Infertility, extrapulmonary tuberculosis, tuberculous meningitis. GirişTüberküloz, ülkemizde önemli morbidite ve mortalite nedenidir. Sosyoekonomik düzeyi düşük toplumlarda ve HIV infeksiyonu gibi immünosüpresyonu olan kişiler-de daha sık görülmektedir. Hastalık araştırılırken akla getirilmezse kolaylıkla atlanabilir, tanı gecikebilir ve buna bağlı morbidite ve mortalite artabilir (1-4). Ekstrapulmoner tüberküloz (EPT) Mycobacterium tuberculosis'in akciğer dışında yerleşimi sonucu gelişen klinik tablodur (2,3,5,6). EPT formları sıklıkla immünosüpresyon sonrası ortaya çıkar. Tüberkülöz menenjit EPT'nin en ciddi klinik formudur (6-10). Genital tüberküloz ve tüberkülöz menenjit, primer infeksiyon sonrasında oluşan granü-lom odaklarından köken alır. Genital tüberkülozun üç ana semptomu infertilite, pelvik ağrı ve menstrüel değişikliklerdir. En sık semptom %45-55 oranında görülen infertilitedir (11)(12)(13)(14)(15)(16)(17). Bu yazıda yedi yıldır infertilite nedeniyle izlenen hastada ikiz doğum sonrası gelişen tüber-külöz menenjit olgusu sunulmuştur. Olgu34 yaşında kadın, kliniğimize baş ağrısı, bilinç bulanıklığı ve ateş yakınmalarıyla başvurdu. Hastanın anamnezinden yedi yıldır infertilite tedavisi gördüğü öğrenil-di. İnfertilite nedeni araştırılırken hastaya iki kez endometriyum biyopsisi yapıldığı, alınan materyalin patolojisinde granülomatöz iltihap saptandığı, fakat etyolojiye yönelik ileri araştırma yapılmadığı öğrenildi.İntrauterin inseminasyon yöntemiyle gebe kalan hasta, 15 gün önce sezaryenle ikiz canlı bebek dünyaya getirmişti. Doğumdan bir hafta sonra başlayan bulantı, kusma ve karın ağrısı yakınmalarıyla başvurduğu kadın hastalıkları ve doğum kliniğinde ultrasonografi k olarak saptanan karın içi apse cerrahi olarak boşaltılmış ve parenteral geniş spektrumlu antibiyotik tedavisi başlan-mıştı. Apse materyalinin histopatolojik incelemesinde Langhans ...

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Approach to the diagnosis and management of tuberculous meningitis

Cited by 13 publications

References 41 publications

Thwaites’ Diagnostic Scoring and the Prediction of Tuberculous Meningitis

Thwaites’ Diagnostic Scoring and the Prediction of Tuberculous Meningitis

Tuberculous meningitis: The challenges

Tuberculous Meningitis during Pregnancy in a Patient Treated for Infertility: A Case Report

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