Clinical and Cerebrospinal Fluid Abnormalities as Diagnostic Tools of Tuberculous Meningitis
Abstract
Background: Tuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculous (TB) disease and remains difficult to diagnose. The aim of the study was to determine the diagnostic value of clinical and laboratory findings of cerebrospinal fluid (CSF) examinations for diagnosing TBM using bacterial culture result as the gold standard.
Methods: A prospective cross sectional study was carried out to 121 medical records of hospitalized TBM patients in neurological ward at Dr. Hasan Sadikin General Hospital Bandung, from 1 January 2009–31 May 2013. The inclusion criteria were medical records consisted of clinical manisfestations and laboratory findings. The clinical manisfestations were headache and nuchal rigidity, whereas the laboratory findings were CSF chemical analysis (protein, glucose, and cells) and CSF microbiological culture. Validity such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) for clinical and laboratory findings were calculated, using bacterial culture result as the gold standard.
Results: The most clinical findings of TBM was nuchal rigidity and it had the highest sensitivity value, but the lowest spesificity value. Decreased of CSF glucose had the highest sensitivity value compared to other laboratory findings, but the value was low.
Conclusions: The clinical manisfestations and the laboratory findings are not sensitive and specific enough for diagnosing TBM. [AMJ.2016;3(1):132–6]
DOI: 10.15850/amj.v3n1.725
Keywords
Full Text:
PDFReferences
WHO. Global tuberculosis report 2012. Geneva: World Health Organization, 2012.
Tai MLS. Tuberculous meningitis: diagnostic and radiological features, pathogenesis and biomarkers. Neuroscience & Medicine. 2013;4(2):101 ̶ 7.
Pedoman Nasional Pengendalian Tuberkulosis. In: Indonesia KKR, editor. 2nd ed. Jakarta: Kementrian Kesehatan Republik Indonesia Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan; 2011. p. 1 ̶ 99.
CDC. Reported tuberculosis in United States 2011. Atlanta: Central for Disease Control and Prevention; 2012. p. 1 ̶ 154.
Pasco PM. Diagnostic features of tuberculous meningitis: a cross-sectional study. BMC Res Notes. 2012;5:49.
Galimi R. Extrapulmonary tuberculosis: tuberculosis meningitis new developments. Eur Rev Med Pharmacol Sci. 2011;15(4):365 ̶ 86.
Rock RB, Olin M, Baker CA, Molitor TW, Peterson PK. Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev. 2008;21(2):243 ̶ 61.
Chaidir L, Ganiem AR, Van der Zanden A, Muhsinin S, Kusumaningrum T, Kusumadewi I, et al. Comparison of real time IS6110-PCR, microscopy, and culture for diagnosis of tuberculous meningitis in a cohort of adult patients in Indonesia. PloS One. 2012;7(12):e52001.
Basuki A, Dian S, editors. Neurology in daily practise. 2nd ed. Bandung: Bagian/UPF Ilmu Penyakit Saraf Fakultas Kedokteran UNPAD/ RS. Hasan Sadikin; 2011.
Christie LJ, Loeffler AM, Honarmand S, Flood JM, Baxter R, Jacobson S, et al. Diagnostic challenges of central nervous system tuberculosis. Emerg Infect Dis. 2008;14(9):1473 ̶ 5.
Waghdhare S, Kalantri A, Joshi R, Kalantri S. Accuracy of physical signs for detecting meningitis: a hospital-based diagnostic accuracy study. Clin Neurol Neurosurg. 2010;112(9):752 ̶ 7.
Marais S, Thwaites G, Schoeman JF, Torok ME, Misra UK, Prasad K, et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis. 2010;10(11):803 ̶ 12.
Quan C, Lu C-Z, Qiao J, Xiao B-G, Li X. Comparative evaluation of early diagnosis of tuberculous meningitis by different assays. J Clin Microbiol. 2006;44(9):3160 ̶ 6.
CDC. Diagnosis of tuberculosis. Atlanta: Central for Disease Control and Prevention; 2005. p. 75 ̶ 107.
Velenzuela PB, Mendoza MT, Ang C, Guzman JD. Validation of the Thwaites' diagnostic rule in the diagnosis of tuberculous meningitis in adults at the Philippine General Hospital. Philippine J Microbiol Infect Dis. 2008;37(1):11 ̶ 9.
Thwaites GE, Tran TH. Tuberculous meningitis: many questions, too few answers. Lancet Neurol. 2005;4(3):160 ̶ 70.
Article Metrics
Abstract view : 488 timesPDF - 247 times
This Journal indexed by
AMJ is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
View My Stats