Zhu Xujie, Li Rui, Zhang Xiaoxin, Wang Dian, Wang Yijie, Lin Wenxin, Zhang Shengkun, Chu Ming, Wei Lanlan
Central lab (Genetics lab), Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen 518172, PR China.
School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China.
Diagn Microbiol Infect Dis. 2025 Nov;113(3):116932. doi: 10.1016/j.diagmicrobio.2025.116932. Epub 2025 Jun 3.
Tuberculous meningitis (TBM), the most severe extrapulmonary manifestation of Mycobacterium tuberculosis (Mtb) infection, contributes to 5-10 % of global tuberculosis-related mortality. This study aimed to delineate clinical indicators predictive of microbiologically confirmed TBM to facilitate early diagnosis in resource-limited settings.
A retrospective cohort analysis was conducted on 146 TBM cases admitted to Shenzhen Third People's Hospital (2018-2020), undergoing cerebrospinal fluid (CSF) culture and Xpert. Epidemiologic profiles and clinical outcomes were systematically characterized. Multiple correspondence analysis (MCA) adjusted for potential confounders was employed to identify clinical indicators associated with microbiologically confirmed TBM.
Among 146 patients with defined or probable TBM, 80 cases were detected for Mtb in CSF, with undetected in 66 cases. The increase in CSF white cell count was more significant than that in blood. Serum sodium, serum chloride (Cl), CSF glucose, CSF Cl, and CSF to blood glucose ratio in microbiologically confirmed TBM were significantly lower than those in unconfirmed TBM, in addition to having worse nutrition and lower blood lymphocytes. MCA identified diagnostic indicators related to microbiologically confirmed TBM included neck stiffness, decreased blood lymphocyte counts and serum sodium, elevated CSF white cell count, decreased CSF glucose and Cl levels, HIV positivity, severe pulmonary infection, and malnutrition. However, Hypertension and pulmonary tuberculosis were associated with microbiologically unconfirmed TBM.
The clinical indicators identified in this study may assist clinicians in high-tuberculosis-incidence-areas, particularly in regions with limited capacity for CSF microbial culture, to empirically diagnose TBM. When these indicators are abnormal, they may increase the likelihood of detecting microbial evidence in CSF.
结核性脑膜炎（TBM）是结核分枝杆菌（Mtb）感染最严重的肺外表现形式，占全球结核病相关死亡率的5%-10%。本研究旨在确定微生物学确诊TBM的临床预测指标，以便在资源有限的环境中促进早期诊断。
对深圳市第三人民医院收治的146例TBM病例（2018-2020年）进行回顾性队列分析，这些病例均接受了脑脊液（CSF）培养和Xpert检测。系统地描述了流行病学特征和临床结局。采用多对应分析（MCA）并对潜在混杂因素进行校正，以确定与微生物学确诊TBM相关的临床指标。
在146例确诊或疑似TBM患者中，80例脑脊液中检测到Mtb，66例未检测到。脑脊液白细胞计数的增加比血液中更显著。微生物学确诊的TBM患者的血清钠、血清氯（Cl）、脑脊液葡萄糖、脑脊液Cl以及脑脊液与血糖比值均显著低于未确诊的TBM患者，此外，其营养状况更差，血液淋巴细胞水平更低。MCA确定的与微生物学确诊TBM相关的诊断指标包括颈部僵硬、血液淋巴细胞计数和血清钠降低、脑脊液白细胞计数升高、脑脊液葡萄糖和Cl水平降低、HIV阳性、严重肺部感染和营养不良。然而，高血压和肺结核与微生物学未确诊的TBM相关。
本研究确定的临床指标可能有助于结核病高发地区的临床医生，特别是脑脊液微生物培养能力有限地区的医生，凭经验诊断TBM。当这些指标异常时，可能增加在脑脊液中检测到微生物证据的可能性。
