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[Differential diagnosis in patients with tuberculous meningitis and cryptococcal meningitis]
1Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University of Medical Sciences, Guangzhou 510630.
Objective:
To search for the main differential points in clinical and CSF changes between patients with tuberculous meningitis (TBM) and cryptococcal meningitis (CCM).
Methods:
Fifty three cases of TBM and 55 cases of CCM who admitted to hospital from February 1983 to December 1997 were investigated retrospectively. Main symptoms, signs and CSF changes before administration of specific antibiotics were compared.
Results:
9%(5/53) TBM and 49% (27/55) CCM patients had headache without fever at the onset. The incidences of symptoms of failing eyesight, hearing loss and paralysis of extremities were 13% (7/53) and 36%(20/55), 2% (1/53) and 16% (9/55), and 19% (10/53) and 0 in TBM and CCM patients respectively. The rate and the degrees of optic papilla edema in CCM patients (66%, 16/36 slight, 13/36 moderate, and 7/36 serious) were significantly higher and more serious than that in TBM (15%, 8/8 slight). The patients with initial CSF pressure over 400 mm H2O were 11% and 90% in TBM and CCM. All but 20 CCM patients had elevation of CSF protein content, and 45% (24/53) TBM and 9%(5/55) CCM were > 2 g/L.
Conclusions:
This study shows that the most important differences between TBM and CCM are: headache not accompanied by fever at the onset, failing eyesight, striking elevation of initial CSF pressure, moderately and serious degree of optic papilla edema, normal CSF protein content occurs usually in CCM more than those in TBM patients. On the other hand, striking elevation of CSF protein content (> 2 g/L) occurs usually in TBM patients.