Tuberculous meningitis diagnosis and treatment in adults: A series of 189 suspected cases

Luo,Mengchuan; Wang,Weifei; Zeng,Qiuming; Luo,Yuebei; Yang,Huan; Yang,Xiaosu

doi:10.3892/etm.2018.6496

September-2018 Volume 16 Issue 3

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September-2018 Volume 16 Issue 3

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Article

Tuberculous meningitis diagnosis and treatment in adults: A series of 189 suspected cases

Authors:
- Mengchuan Luo
- Weifei Wang
- Qiuming Zeng
- Yuebei Luo
- Huan Yang
- Xiaosu Yang
View Affiliations / Copyright

Affiliations: Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China, Department of Neurology, People's Hospital of Liaocheng, Liaocheng, Shandong 252000, P.R. China
Pages: 2770-2776
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Published online on: July 20, 2018

https://doi.org/10.3892/etm.2018.6496
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Abstract

The present study aimed to summarize the clinical features, alterations in cerebrospinal fluid (CSF), imaging characteristics, diagnostic methods, treatment regimens and outcomes of adult Chinese patients with tuberculous meningitis (TBM). Clinical data of 189 cases with 4 cases confirmed with definite TBM, 65 cases of probable (diagnostic score, ≥12 with imaging or ≥10 without imaging) and 120 cases of possible (diagnostic score, 6‑11 with imaging or 6‑9 without imaging) TBM admitted to Xiangya Hospital of Central South University between January 2009 and January 2015 were investigated retrospectively. Data on the clinical, laboratory and demographic characteristics of patients, as well as the results of radiological investigations and the clinical outcome, were collected for all patients. A total of 89.9% patients illustrated symptoms of acute or sub‑acute TBM. The most frequent symptoms and signs were fever (78.3%), headache (89.2%), decreased level of consciousness (48.1%), meningeal irritation (73%), impairment of cranial nerve function and increased intracranial pressure (60%). The CSF protein concentration was significantly elevated and CSF glucose was greatly decreased in these cases. Imaging data were available for 144 cases, with 66 cases presenting abnormal chest X‑ray or computed tomography findings, and 127 cases presenting abnormal brain magnetic resonance imaging findings among the 144 patients examined. All patients received anti‑tuberculosis (TB) therapy, while 7 patients underwent neurosurgical drainage due to hydrocephalus and 3 patients succumbed to the disease. Among the survivors, 87% presented significant improvement. In conclusion, the diagnosis of TBM should combine clinical manifestations, CSF examination and the effect of anti‑TB therapy. Differential diagnosis and trial anti‑TB therapy may be of help for diagnosis. Positive CSF smear, CSF culture and biopsy of the brain, or biopsy of meninges are golden standards for the diagnosis of TBM. Early diagnosis and treatment are very important for improving the outcome.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Tuberculous meningitis diagnosis and treatment in adults: A series of 189 suspected cases

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