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[结核性脑膜脑炎的诊断难点]

[Diagnostic difficulties in tuberculosis meningoencephalitis].

作者信息

Piekarska Anna, Kuydowicz Jan

机构信息

Klinika Chorób Zakaźnych AM w Łodzi.

出版信息

Pneumonol Alergol Pol. 2002;70(9-10):504-8.

Abstract

Tuberculous meningoencephalitis (TBM) is a rarely diagnosed form of tuberculosis. It is characterised with high mortality. Only rapidly started treatment allows to patient's survival. However, bacteriologic prove of the diagnosis is achieved only in 40% of cases. It was hoped that introduction of PCR to clinical practice, would allow rapid and unquestionable diagnosis. We present case of male with lymphocytic bacterial meningoencephalitis in whom tuberculous etiology was suspected. The diagnosis was abandoned when negative results of PCR was obtained. As cessation of treatment led to dramatic worsening of patients state, the antituberculosis therapy was restarted. After 2 months of therapy, complete clinical remission was achieved. Nevertheless, computed tomography of brain revealed clinically asymptomatic hydrocephalus. Presented case shows that the treatment is effective, it should not be ended even in case of negative results of PCR test.

摘要

结核性脑膜脑炎(TBM)是一种罕见的结核病诊断类型。其特点是死亡率高。只有迅速开始治疗才能使患者存活。然而,仅40%的病例能获得诊断的细菌学证据。人们曾希望将聚合酶链反应(PCR)引入临床实践能实现快速且明确的诊断。我们报告一例疑似结核病因的淋巴细胞性细菌性脑膜脑炎男性病例。当PCR结果为阴性时,放弃了该诊断。由于停止治疗导致患者病情急剧恶化,于是重新开始抗结核治疗。治疗2个月后,实现了完全临床缓解。然而,脑部计算机断层扫描显示存在临床无症状的脑积水。该病例表明治疗是有效的,即使PCR检测结果为阴性也不应停止治疗。

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