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Cross sectional study of 39 Cases of Tuberculous Meningitis in North Bihar

Munish Kumar; Avinash Goswami; Jayant Kumar Singh; Manoj Kumar Rastogi; Kamlesh Tewary.

Background: Tuberculous meningitis (TBM) is the most severe manifestation of extrapulmonary tuberculosis with a high mortality and morbidity rates. Exact prevalence of Central nervous system tuberculosis in India is not known, but it accounts for an estimated 1% of all cases of TB, which equates to around 17000 cases in India in 2014. The aims of the study are (1) to review the clinical, laboratory, disease staging and radiological findings of 39 TBM cases at a single center. (2) to present the local epidemiological data from our cases.

Methods: Thirty -nine patients admitted to our tertiary hospital with symptoms and signs of meningitis were selected and on the basis of adopted criteria labeled as tuberculous meningitis. Clinical profile, disease staging and cerebrospinal fluid (CSF) findings noted in each patient. adenosine deaminase (ADA) level in CSF estimated. Cut off value of ADA kept at or above 10 IU/L for tubercular meningitis. Comparative study done with 23 patients of pyogenic meningitis.

Results: The mean age of patients with tubercular meningitis was 39.07 ± 16.67 years. The symptom duration range from 7 to 98 days with a median of 28 days. Clinically fever was present in 37 (94.8 %), headache in 29 (74.3 %), and vomiting in 22 (56.4 %) patients. Six (15.38 %) patients had seizure. On CSF cytological and biochemical analysis the mean total white blood cell count was 256.74 ± 184.03 /cmm, mean protein 182.22 ± 113.12 mg/ dl and mean sugar 52.85 ± 19.3. The CSF / Blood glucose ratio in TBM case was 0.41. Out of 39 TBM patients, 33 patients were found to be having CSF ADA at or above the cutoff value of 10 IU/L while six had below cutoff value. On comparison between two groups, the CSF ADA level found to be highly significant (P < 0.001). On cranial CT or MRI 28.2 % patients had hydrocephalous, 7.6 % with tuberculoma and 5.1 % with spinal arachnoiditis. About one third patients had evidence of active tuberculosis on chest X-ray.

Conclusions: Any patient presenting either acutely or chronically with signs and symptoms of meningitis, urgent CSF examination should be done to diagnose tuberculous meningitis on the basis of CSF lymphocytic pleocytosis, decreased glucose, increased protein, and ADA more than 10 IU/L. Because of high mortality and morbidity early initiation of antitubercular drugs may prevent sequel.

Key words: Tuberculous Meningitis;Clinical features;Adenosine Deaminase

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