Prediction of cerebrospinal fluid parameters for tuberculous meningitis

Zou, Yueli; He, Jianxing; Guo, Li; Bu, Hui; Liu, Yajuan

doi:10.1002/dc.23284

Cited by 11 publications

(10 citation statements)

References 17 publications

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“…For decades, there have been many descriptions of assays testing meaningful factors in TBM, such as adenosine deaminase (ADA), lactic acid and LDH in CSF, procalcitonin, serum sodium, and cranial nerve palsy symptoms, among others. 15 16 31 32 33 34 However, each factor alone cannot distinguish between TBM and other forms of meningitis. Therefore, before TB culture results can be obtained, a simple diagnostic system that synthesizes statistically meaningful predictors is necessary.…”

Section: Discussionmentioning

confidence: 99%

A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis

et al. 2018

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BackgroundTuberculous meningitis (TBM) is associated with high mortality and morbidity despite administering anti-tuberculous chemotherapy to the patients. Differential diagnosis between TBM and viral meningitis (VM) is difficult in some clinical situations.MethodsWe reviewed and analyzed records of adult patients who were admitted and diagnosed with TBM or VM at a tertiary hospital in Korea, between January 2006 and December 2015. Diagnostic criteria for TBM were categorized into three groups: definite, probable, and possible TBM. The VM group included patients with no evidence of other meningitis who achieved complete recovery with only conservative treatments. Clinical, laboratory and radiological findings, as well as outcomes, were compared between the TBM and VM groups.ResultsNinety-eight patients were enrolled. Among the study patients, 47 had TBM and 51 had VM. Based on univariate analysis and multivariate logistic regression, sodium < 135 mmol/L in serum (hyponatremia), lactate dehydrogenase > 70 (U/L) in cerebrospinal fluid (CSF), protein > 160 (mg/dL) in CSF, voiding difficulty, and symptoms of cranial nerve palsy were significant predictive factors for TBM in the final model. We constructed a weighted scoring system with predictive factors from multiple regression analyses. Receiver operating characteristic curve analyses and decision tree analyses were plotted to reveal an optimum cutoff point as 4 with this scoring system (range: 0–13).ConclusionFor differential diagnosis between TBM and VM, we created a new weighted scoring system. This scoring system and decision tree analysis are simple and easy to apply in clinical practice to differentiate TBM from VM.

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Section: Discussionmentioning

confidence: 99%

A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis

et al. 2018

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“…The presence of granulocytes in the CSF in neoplastic meningeosis suggests a contribution of the innate immune system to the inflammatory reaction. In tuberculous meningitis which also is characterized by a strong elevation of CSF lactate and total protein and a moderate elevation of cell counts (10–500 cells/μl), neutrophil predominance (>50%) [21] was a strong predictor of tuberculous meningitis with a sensitivity of 54% and a specificity of 98% [22]. Since only two of the 55 CSF samples in our study, where differential cell counts were carried out, contained >50% granulocytes, neutrophilic predominance in CSF is an argument against the diagnosis of meningeosis neoplastica.…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal fluid abnormalities in meningeosis neoplastica: a retrospective 12-year analysis

Djukic

Trimmel

Nagel

et al. 2017

Fluids Barriers CNS

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BackgroundMeningeosis neoplastica is a diffuse metastatic spread of tumor cells in the subarachnoid space. Although first recognized in 1870, systematic investigations regarding cerebrospinal fluid (CSF) constituents in this condition are scarce.MethodsRoutine CSF samples analyzed from 2001 to 2012 at the Laboratory of Clinical Neurochemistry, University of Göttingen, were re-evaluated. Patients, whose CSF contained malignant cells were included in this study.ResultsPatients (n = 132, age 59.1 ± 29.1, 58% women) were identified, whose CSF contained malignant cells. The most frequent primary tumor was breast cancer (32.6%), followed by lung cancer (25.0%) and hematologic malignancies (21.2%). The most frequent clinical symptoms were affections of cranial nerves (41.7%), psychiatric abmormalities (32.6%) and radicular lesions of the lower extremities (20.5%). CSF cell counts ranged from 0 to 4692 cells/μl (median 4 cells/μl) and were elevated in 50%. The CSF-to-serum albumin ratio was abnormal in 69.4%. It ranged from 1.8 to 330 x 10-3 (median 17.5 x 10-3). Total CSF protein ranged from 166 to 15,840 mg/l (median 1012 mg/l). CSF lactate was elevated (>2.4 mmol/l) in 65.2% [3.6 mmol/l (1.3/15.6 mmol/l); median (minimum/maximum)]. In 50% of all patients CSF lactate was ≥3.5 mmol/l. The CSF cell counts correlated significantly with the CSF lactate levels and the CSF protein contents. In 56 of 118 CSF samples (47.5%) ferritin was elevated, and in 25 of 65 carcinoma patients (38.5%) an intrathecal production of carcinoembryonic antigen (CEA) was detected. Granulocytes were found in 52.7% of the CSF samples. The percentages of granulocytes and lymphocytes were higher in samples with an elevated cell count.ConclusionIn approximately 50% of CSF samples with meningeosis neoplastica the CSF cell count is not elevated. Diagnosis may be missed when only CSF samples with elevated cell counts are subjected to cytological analysis. CSF lactate and protein and the CSF-to-serum albumin ratio are frequently increased in meningeosis neoplastica. The differential diagnosis between meningeosis neoplastica and central nervous infections, in particular tuberculous or fungal meningitis, can be difficult.

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“…The application of molecular diagnostic techniques, including polymerase chain reaction and nextgeneration sequencing in CSF studies is booming in an era of precision medicine [19,20] . These novel techniques may be used to diagnose neoplastic meningopathy without cytological evidence [19,20] .…”

Section: Csf Cytology Of Neoplastic Disordersmentioning

confidence: 99%

“…These novel techniques may be used to diagnose neoplastic meningopathy without cytological evidence [19,20] . However a final diagnosis based only on molecular techniques without morphological or cytological evidence should be avoided in clinical practice in order to prevent risks of over-diagnosis and misdiagnosis.…”

Section: Csf Cytology Of Neoplastic Disordersmentioning

confidence: 99%

Clinical application of cerebrospinal fluid cytology in China

Guan¹,

Zhao²

2018

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Cerebrospinal fluid (CSF) cytology is a fundamental test for the diagnosis of central nervous system (CNS) disease in neurological practice in China. CSF cytology provides diagnostic evidence in cases suspected of CNS infectious diseases, autoimmune encephalitis and CNS neoplastic disorders. Immunocytochemistry and flow cytometry make the cytological diagnosis more sensitive and specific. However, the diagnostic significance of CSF cytology should be interpreted and evaluated in the context of specific clinical backgrounds. Although molecular diagnostic techniques, including polymerase chain reaction and next-generation sequencing, are increasingly applied to CSF examination, the classical CSF cytology still has its horizon in the era of precision neurology and should be recommended as a routine test for CSF analysis.

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Prediction of cerebrospinal fluid parameters for tuberculous meningitis

Abstract: The cerebrospinal fluid parameters can help the clinicians to make a prompt diagnosis in the early stage of the disease.

Cited by 11 publications

References 17 publications

A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis

A New Scoring System for the Differential Diagnosis between Tuberculous Meningitis and Viral Meningitis

Cerebrospinal fluid abnormalities in meningeosis neoplastica: a retrospective 12-year analysis

Clinical application of cerebrospinal fluid cytology in China

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