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Positive bromide partition test in the absence of tuberculous meningitis
Abstract:
Five cases of lymphocytic meningitis are described where a Bromide Partition Test was performed and proved positive at levels usually considered consistent with tuberculous meningitis. Three of these cases were ultimately shown to have herpes simplex viral encephalitis, one had Listeria monocytogenes in the CSF and the fifth patient recovered without treatment and was thought to have had a viral encephalitis. The Bromide Partition Test may not be as good a discriminant as has previously been suggested in differentiating between tuberculous and viral meningitis, especially when performed in a population at low risk of getting tuberculous meningitis.
Insights
The Bromide Partition Test may be unreliable for distinguishing tuberculous meningitis from viral causes like herpes simplex encephalitis. This test showed positive results in cases later diagnosed with viral meningitis or Listeria, questioning its diagnostic accuracy.
Area of Science:
- Neurology
- Infectious Diseases
- Clinical Diagnostics
Background:
- The Bromide Partition Test is a diagnostic tool used to differentiate between tuberculous meningitis and other forms of meningitis.
- Elevated bromide levels in cerebrospinal fluid (CSF) have been traditionally associated with tuberculous meningitis.
Observation:
- This study describes five cases of lymphocytic meningitis where the Bromide Partition Test yielded positive results, suggesting tuberculous meningitis.
- However, subsequent investigations revealed alternative diagnoses in these patients.
Findings:
- Three cases were diagnosed with herpes simplex viral encephalitis.
- One case involved Listeria monocytogenes meningitis.
- The fifth patient recovered spontaneously and was presumed to have viral encephalitis.
Implications:
- The Bromide Partition Test may not be a reliable discriminant between tuberculous and viral meningitis.
- Its accuracy is particularly questionable in populations with a low incidence of tuberculous meningitis.
- Rethinking the utility of the Bromide Partition Test in diagnosing meningitis is warranted.