Pinto Vitor Laerte, Lima Marco Antonio, Rolla Valéria Cavalcanti, Rebelo Maria Cristina, Bóia Marcio Neves
Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Av. Brasil 4365, Manguinhos 21040-360, Rio de Janeiro, Brazil.
Trop Doct. 2009 Apr;39(2):76-8. doi: 10.1258/td.2008.080242.
The aim of this study was to describe atypical cerebrospinal fluid (CSF) alterations in tuberculous meningitis (TBM) and to analyse the differences in outcome between patients with typical and atypical profiles. We did a retrospective study during the period of 2000 to 2005 including the cases of TBM assisted in a referral centre for infectious diseases in Rio de Janeiro State, Brazil. Neutrophilic plecytosis at the first spinal tap was found in 32.4% of TBM patients, who had a worse outcome when compared with those patients with typical CSF profiles. One factor that might have a major impact was the delay in starting empirical treatment (27.5 versus 11.6 days). We conclude that, in cases with clinical and epidemiological data compatible with TBM but with an atypical CSF profile, empirical treatment should be considered if CSF culture and direct examination for bacteria are negative.
本研究的目的是描述结核性脑膜炎（TBM）患者脑脊液（CSF）的非典型改变，并分析典型和非典型病例患者预后的差异。我们进行了一项回顾性研究，研究时间段为2000年至2005年，纳入了巴西里约热内卢州一家传染病转诊中心收治的TBM病例。在32.4%的TBM患者首次腰椎穿刺时发现中性粒细胞增多，与典型脑脊液特征的患者相比，这些患者的预后较差。一个可能产生重大影响的因素是开始经验性治疗的延迟（27.5天对11.6天）。我们得出结论，对于临床和流行病学数据符合TBM但脑脊液特征不典型的病例，如果脑脊液培养和细菌直接检查均为阴性，则应考虑进行经验性治疗。
