Paciorek Marcin, Pihowicz Andrzej, Bursa Dominik, Schöntaler Humięcka Joanna, Kowalska Justyna D, Antosiewicz Mateusz, Thompson Magda E, Skrzat-Wojdacz Agata, Bednarska Agnieszka, Horban Andrzej
Department for Adult's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland.
Department of Intensive Care for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland.
Adv Med Sci. 2017 Sep;62(2):374-377. doi: 10.1016/j.advms.2016.11.003. Epub 2017 May 23.
Our objective was to investigate whether diagnosis of tuberculous meningitis (TBM) with microbiological and molecular analysis was affected by prior empirical non anti tuberculosis antibiotics or by duration of symptoms before lumbar puncture.
We retrospectively evaluated medical records of patients with TBM confirmed by positive culture, nucleic acid amplification techniques (NAATs) or Ehrlich-Ziehl-Neelsen staining (EZNs) from the cerebrospinal fluid (CSF) or by characteristic results of biochemical analysis of CSF combined with a typical clinical manifestation.
68 adult patients were analyzed. The isolation rates for NAATs, Lowenstein-Jensen (LJ) culture, BACTEC and EZNs were 70.6%, 69.1%, 67.6% and 26.5%, respectively. Biochemical analysis of CSF samples revealed: pleocytosis (median 224 [range 78-380]cells/mm) with lymphocyte predominance (76 [45-90]%), elevated levels of protein (2.43 [1.50-3.84]g/l) and lactic acid (5.0 [3.9-7.2]mmol/l). Forty (65%) patients received no anti-tuberculosis antibiotic treatment before the diagnostic lumbar puncture. The were no significant differences in the microbiological and biochemical CSF analyses, between the patients who received and those who did not receive non anti-TB empirical antibiotic treatment. The median duration of symptoms before the diagnostic lumbar puncture was 24 (range 11-61) days. No significant differences in microbiological and biochemical analysis of CSF where found when comparing patients with duration of symptoms lasting above and less than the median time.
Neither prior non anti-TB antibiotic therapy, nor the duration of symptoms before diagnostic lumbar puncture have any effect on confirmation of TBM by microbiological and biochemical CSF analysis.
我们的目的是研究结核性脑膜炎（TBM）的微生物学和分子分析诊断是否会受到先前经验性使用的非抗结核抗生素或腰椎穿刺前症状持续时间的影响。
我们回顾性评估了经脑脊液（CSF）培养阳性、核酸扩增技术（NAATs）或埃利希-齐尔-尼尔森染色（EZNs）确诊为TBM的患者的病历，或通过CSF生化分析的特征性结果结合典型临床表现确诊的患者病历。
分析了68例成年患者。NAATs、罗氏培养基（LJ）培养、BACTEC和EZNs的分离率分别为70.6%、69.1%、67.6%和26.5%。CSF样本的生化分析显示：细胞增多（中位数224[范围78 - 380]个细胞/mm），以淋巴细胞为主（76[45 - 90]%），蛋白水平升高（2.43[1.50 - 3.84]g/l）和乳酸水平升高（5.0[3.9 - 7.2]mmol/l）。40例（65%）患者在诊断性腰椎穿刺前未接受抗结核抗生素治疗。接受和未接受非抗结核经验性抗生素治疗的患者在CSF微生物学和生化分析方面无显著差异。诊断性腰椎穿刺前症状的中位持续时间为24（范围11 - 61）天。比较症状持续时间高于和低于中位时间的患者时，CSF微生物学和生化分析无显著差异。
先前的非抗结核抗生素治疗以及诊断性腰椎穿刺前的症状持续时间对通过CSF微生物学和生化分析确诊TBM均无影响。
