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Diagnostic features of tuberculous meningitis: a cross-sectional study

Paul Matthew Pasco1

  • 1Dept of Neurosciences, UP-PGH Medical Center, Taft Ave, Manila, Philippines. pmdpasco@post.upm.edu.ph.

BMC Research Notes
|January 24, 2012
PubMed
Abstract

Insights

Diagnosing tuberculous meningitis (TBM) is challenging. In patients with chronic meningitis, only abnormal cerebrospinal fluid (CSF) findings, including pleocytosis, low glucose, and high protein, reliably indicate TBM.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Public Health

Background:

  • Tuberculous meningitis (TBM) is a prevalent central nervous system infection in the Philippines.
  • Diagnosis of TBM is often difficult due to non-specific clinical and radiological findings.
  • Identifying specific diagnostic markers for TBM in patients with chronic meningitis syndrome is crucial.

Purpose of the Study:

  • To determine clinical and laboratory findings associated with the diagnosis of tuberculous meningitis (TBM) among patients presenting with chronic meningitis syndrome.
  • To evaluate the diagnostic utility of new-onset seizures, focal neurologic deficit, pulmonary tuberculosis on chest X-ray, and cerebrospinal fluid (CSF) abnormalities.

Main Methods:

  • Adult patients with suspected TBM were enrolled in the study.
  • Diagnostic tests included physical examination, CT scan of the head with contrast, and CSF analysis (AFB smear, TB culture, cryptococcal antigen).
  • Logistic regression analysis was employed to identify factors associated with a definite TBM diagnosis.

Main Results:

  • Out of 91 patients, 44 met the criteria for definite TBM, while 68 had a final diagnosis of TBM considering clinical course and treatment response.
  • New-onset seizures, focal neurologic deficit, and pulmonary tuberculosis were not significantly associated with TBM diagnosis.
  • Abnormal CSF findings (pleocytosis with lymphocytic predominance, decreased glucose, and increased protein) were the only factors significantly associated with TBM.

Conclusions:

  • In patients with chronic meningitis syndrome, cerebrospinal fluid (CSF) analysis is key for TBM diagnosis.
  • Specific CSF abnormalities, including lymphocytic pleocytosis, low glucose, and high protein, are strongly associated with tuberculous meningitis.
  • Further investigation into the diagnostic value of CSF parameters in TBM is warranted.

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