Pasco Paul Matthew
Dept of Neurosciences, UP-PGH Medical Center, Taft Ave, Manila, Philippines.
BMC Res Notes. 2012 Jan 20;5:49. doi: 10.1186/1756-0500-5-49.
Tuberculous meningitis (TBM) is a common central nervous system infection in the Philippines; however it is difficult to diagnose as findings are non-specific. Hence we decided to determine if, among patients with chronic meningitis syndrome, the following are associated with the diagnosis: new-onset seizures; focal neurologic deficit; pulmonary tuberculosis (PTB) on chest X-ray; cerebrospinal fluid (CSF) pleocytosis with lymphocytic predominance; decreased CSF glucose; increased CSF protein.
Adult patients with suspected TBM were enrolled after informed consent was obtained. Baseline physical examination and diagnostic tests including CT scan of the head with contrast and CSF analysis for acid fast bacilli (AFB) smear, TB culture and cryptococcal antigen detection were done and results collected. Definite TBM was defined as positive AFB smear or positive TB culture or positive basal meningeal enhancement on CT contrast study. Logistic regression was done to determine which were associated with a diagnosis of TBM.
91 patients were included. Using the gold standard criteria mentioned above, 44 had definite TBM; but if subsequent clinical course and response to anti-Koch's therapy are considered, 68 had a final diagnosis of TBM. After logistic regression was performed, only abnormal CSF (the combination of CSF pleocytosis with lymphocytic predominance, decreased CSF glucose, and increased CSF protein) was associated with the diagnosis of TBM.
In patients with chronic meningitis syndrome, only abnormal CSF was associated with the diagnosis of TBM.
结核性脑膜炎（TBM）是菲律宾常见的中枢神经系统感染；然而，由于其表现不具特异性，诊断较为困难。因此，我们决定确定在慢性脑膜炎综合征患者中，以下因素是否与诊断相关：新发癫痫；局灶性神经功能缺损；胸部X线显示肺结核（PTB）；脑脊液（CSF）细胞增多且以淋巴细胞为主；脑脊液葡萄糖降低；脑脊液蛋白升高。
在获得知情同意后，纳入疑似TBM的成年患者。进行基线体格检查和诊断性检查，包括头部增强CT扫描以及脑脊液抗酸杆菌（AFB）涂片、结核培养和隐球菌抗原检测，并收集结果。确诊TBM定义为AFB涂片阳性、结核培养阳性或CT增强扫描显示基底脑膜强化。采用逻辑回归分析确定哪些因素与TBM诊断相关。
共纳入91例患者。根据上述金标准，44例确诊为TBM；但如果考虑后续临床病程及对抗结核治疗的反应，最终诊断为TBM的有68例。进行逻辑回归分析后，只有脑脊液异常（脑脊液细胞增多且以淋巴细胞为主、脑脊液葡萄糖降低和脑脊液蛋白升高的组合）与TBM诊断相关。
在慢性脑膜炎综合征患者中，只有脑脊液异常与TBM诊断相关。
