Presentation of Tuberculous Meningitis Patients : Study of 30 Cases

Abstract

Tuberculosis is creating immense adverse social and economic burden in Bangladesh. Tuberculous Meningitis results from the haematogenous spread of primary or postprimary pulmonary disease or from the rupture of a subependymal tubercle into the subarachnoid space. Infection of the CNS is one of the most devastating clinical manifestations of tuberculosis This study aimed to see the presentation of tuberculous meningitis patients in tertiary level hospital of Bangladesh. This cross sectional study was carried out in the Department of Neurology, SSMC, Dhaka from June 2011 to July 2012. In the present study, thirty meningitis patients were enrolled, among the subjects 11.7 % were aged below 20 years, 53.3% were aged between 20 - 39 years, 16.7% were aged between 40 - 49 years and 18.3% were aged above 50 years. Regarding sex 56.7% were male and 43.3% were female. Most prevalent symptom was fever (91.7%). Among others, headache (70%), altered consciousness (45%), vomiting (43.3%) and neck stiffness (28.9%) were notable. The distribution of the study subjects by physical sign 55.0% had anemia, 95.0% had neck rigidity, 10.0% had cranial nerve palsy, 46.7% had kernig's sign and 20.0% had long tract sign. Regarding GCS score 10.0 % had GCS score less than 8, 18.3 % had between 9 – 12 and 71.7% had over> 12.The Laboratory finding among the study subjects 3.3% showed positive gram stain and 43.7% showed MT over 10 mm. In response to treatment 93.3% responded to anti TB out of 30 TBM subjects. This study demonstrated that presentation of tubercular meningitis is different in different patient.TBM is the severe form of extra-pulmonary tuberculosis occurring in 7.0- 12.0% of TB patients in developing countries with high rate of mortality due to delay in diagnosis and proper treatment. DOI: http://dx.doi.org/10.3329/medtoday.v25i1.16069 Medicine Today 2013 Vol.25(1): 32-35

An Observational, Cross-sectional Study on Epidemiology and Clinical Spectrum of Tuberculous Meningitis in a Tertiary Care Hospital in Eastern India and Role of CSF CBNAAT for Rapid Diagnosis

“…12 In our study there 52% of the patients were male which was in concordance with the sex distribution in the study done by Sarkar D.N. Hossain MI et al 13 Almost all (94%) TBM patients had fever and most (66%) of them had headache and vomiting, which are very pathognomonic features of meningeal irritation/infection (Table 2). Findings are comparable to the study conducted by Sharma et al and Archana Aher et al In the present study it was shown that 66% patients had meningeal sign which was to some extent corroborative to the study done by Sarkar D.N.…”

Accuracy of Gene-Xpert In Diagnosis of Suspected Tuberculous Meningitis

“…This may be difficult to replicate outside a dedicated research setting due to the work burden in public health laboratories of resource-limited countries like ours 31 . Similar to our finding Sarkar et al, (2013) also observed 100% negative smear microscopy 24 .…”

“…Seizures of generalized tonic and clonic type were noted 15% of our cases while reported 8.3% in Sarkar et al, (2013) 26 . The signs of meningeal irritation was present as neck rigidity or as Kernig's sign in 100% cases while cranial nerve palsies were observed in 43% of the cases, which is consistent with the other study from Bangladesh (42.5%) (Sarkar et al, 2013) but slightly lower than that of Indian study (Khatua et al, 1961) where it was 50% ). In the present study, the incidence of papilloedema was 40%.…”

“…In the present study, history of fever is present in all of the cases (100%) which was close to study by 92% in Sarkar et al, (2013). Seizures of generalized tonic and clonic type were noted 15% of our cases while reported 8.3% in Sarkar et al, (2013) 26 .…”

“…Diagnostic accuracy of Gene-Xpert in comparison to AFB Culture of CSF 24 . In the current study incidence of TBM was higher in female than male.…”