Immunological and molecular technology assisting diagnosis: clinical characteristics analysis of 152 cases of tuberculous meningitis in northern Guizhou_West China Medical Journal

Authors：

WANG Tao ^1,2 , ZHOU Liang ¹ , YANG Hongxia ¹ , TANG Shufu ¹ , LI Nana ¹ ,  CHEN Xuerong ² ,  ZHANG Jianyong ¹

1. Second Department of Respiratory, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563000, P. R. China;
2. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

CHEN Xuerong, Email: 384481688@qq.com; ZHANG Jianyong, Email: 183307838@qq.com

Keywords：

Tuberculous meningitis; Clinical diagnosis; Antituberculosis treatment

DOI：

10.7507/1002-0179.201807132

Video：

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Objective To comprehensively observe, recognize, learn and understand the clinical features of tuberculous meningitis (TBM). Methods We retrospectively analyzed the general data, clinical manifestations, clinical examinations and treatment prognosis of 152 patients with TBM who were hospitalized in the Second Affiliated Hospital of Zunyi Medical College between January 2016 and February 2017. Results The mean age of the 152 patients with TBM was (43.9±20.4) years old, the ratio of male to female was 1.45:1, and the average length of hospital stay was (20.0±18.9) days. The clinical manifestations were mainly headache [95.4% (145/152)], nausea and vomiting [42.8% (65/152)], and fever [61.8% (94/152)]. The main co-morbidities were secondary pulmonary tuberculosis [52.0% (79/152)], hematogenous disseminated tuberculosis [37.5% (57/152)], and tuberculous pleurisy [30.9% (47/152)]. The positive rate of γ-interferon release test was 90.8% (129/142), and the brain pressure of lumbar puncture was elevated. The typical biochemical changes of cerebrospinal fluid were " low glucose, low chlorine, and high protein”. The positive rate of tuberculosis smear was extremely low, and the positive rate of GeneXpert MTB/RIF in cerebrospinal fluid was 21.9% (7/32). The TBM patiens were prone to combine with hypoproteinemia, the proportion reached 29.6% (45/152), and the proportion of hyponatremia reached 45.3% (69/152). Treated with early diagnosis and treatment, 92.1% (140/152) improved and discharged. Conclusions TBM patients are mainly young and middle-aged with various clinical manifestations and less respiratory symptoms; and are easy to be combined with pulmonary tuberculosis and other extrapulmonary tuberculosis. γ-interferon release test and cerebrospinal fluid GeneXpert MTB/RIF can be used for the auxiliary diagnosis of tuberculosis. Early detection, early diagnosis and treatment, rational and regular chemotherapy, strengthening symptomatic supportive treatment, and improving the precise diagnosis and treatment of TBM, can improve its clinical prognosis.

Citation： WANG Tao, ZHOU Liang, YANG Hongxia, TANG Shufu, LI Nana, CHEN Xuerong, ZHANG Jianyong. Immunological and molecular technology assisting diagnosis: clinical characteristics analysis of 152 cases of tuberculous meningitis in northern Guizhou. West China Medical Journal, 2018, 33(8): 972-976. doi: 10.7507/1002-0179.201807132 Copy

1.	Huang HJ, Ren ZZ, Dai YN, et al. Old age and hydrocephalus are associated with poor prognosis in patients with tuberculous meningitis: a retrospective study in a Chinese adult population. Medicine (Baltimore), 2017, 96(26): e7370.
2.	唐神結, 高文. 臨床結核病學. 北京: 人民衛生出版社, 2011: 402-417.
3.	Chin JH, Mateen FJ. Central nervous system tuberculosis: challenges and advances in dianosis and treatment. Curr Infect Dis Rep, 2013, 15(6): 631-635.
4.	Lee HG, William T, Menon J, et al. Tuberculous meningitis is a major cause of mortality and morbidity in adults with central nervous system infections in Kota Kinabalu, Sabah, Malaysia: an observational study. BMC Infect Dis, 2016, 16: 296.
5.	張東升, 張振華. 血行播散型肺結核合并結核性腦膜炎 44 例臨床診治體會. 中外健康文摘, 2013, 10(22): 145-146.
6.	張春艷, 池菲, 張新, 等. 不同方法診斷結核性腦膜炎的價值比較. 疑難病雜志, 2017, 16(4): 356-359, 363.
7.	吳小慧, 劉為勇, 王峰, 等. 評估GeneXpert MTB/RIF技術在結核性腦膜炎診斷中的價值. 神經損傷與功能重建. (2018-07-17). http://kns.cnki.net/kcms/detail/42.1759.R.20180717.1158.002.html.
8.	張瑞雪, 龍銦, 馮國棟, 等. Xpert MTB/RIF對結核性腦膜炎診斷的臨床評價. 中華檢驗醫學雜志, 2016, 39(6): 442-447.
9.	World Health Organization. WHO meeting report of a technical expert consultation: non-inferiority analysis of Xpert MTB/RIF ultra compared to Xpert MTB/RIF: WHO/HTM/TB/2017.4. Geneva: World Health Organization, 2017. http://apps.who.int/iris/handle/10665/254792.
10.	Davis A, Meintjes G, Wilkinson RJ. Treatment of tuberculous meningitis and its complictions in adults. Curr Treat Options Neurol, 2018, 28, 20(3): 5.
11.	邱建東, 董正梁, 王鑫, 等. 結核性腦膜炎合并低鈉血癥 104 例臨床分析. 世界最新醫學信息文摘, 2018, 18(18): 126-127.
12.	唐思穎, 井歡, 王看然, 等. 結核性腦膜炎伴低鈉血癥的臨床特征分析. 重慶醫科大學學報, 2018, 43(6): 793-796.
13.	常占林. 結核性腦膜炎合并低鈉血癥 20 例分析. 西藏醫藥, 2017, 38(4): 19-20.
14.	張朋. 結核性腦膜炎的臨床特征及預后影響因素分析. 中西醫結合心腦血管病雜志, 2015, 13(15): 1778-1780.

1. Huang HJ, Ren ZZ, Dai YN, et al. Old age and hydrocephalus are associated with poor prognosis in patients with tuberculous meningitis: a retrospective study in a Chinese adult population. Medicine (Baltimore), 2017, 96(26): e7370.
2. 唐神結, 高文. 臨床結核病學. 北京: 人民衛生出版社, 2011: 402-417.
3. Chin JH, Mateen FJ. Central nervous system tuberculosis: challenges and advances in dianosis and treatment. Curr Infect Dis Rep, 2013, 15(6): 631-635.
4. Lee HG, William T, Menon J, et al. Tuberculous meningitis is a major cause of mortality and morbidity in adults with central nervous system infections in Kota Kinabalu, Sabah, Malaysia: an observational study. BMC Infect Dis, 2016, 16: 296.
5. 張東升, 張振華. 血行播散型肺結核合并結核性腦膜炎 44 例臨床診治體會. 中外健康文摘, 2013, 10(22): 145-146.
6. 張春艷, 池菲, 張新, 等. 不同方法診斷結核性腦膜炎的價值比較. 疑難病雜志, 2017, 16(4): 356-359, 363.
7. 吳小慧, 劉為勇, 王峰, 等. 評估GeneXpert MTB/RIF技術在結核性腦膜炎診斷中的價值. 神經損傷與功能重建. (2018-07-17). http://kns.cnki.net/kcms/detail/42.1759.R.20180717.1158.002.html.
8. 張瑞雪, 龍銦, 馮國棟, 等. Xpert MTB/RIF對結核性腦膜炎診斷的臨床評價. 中華檢驗醫學雜志, 2016, 39(6): 442-447.
9. World Health Organization. WHO meeting report of a technical expert consultation: non-inferiority analysis of Xpert MTB/RIF ultra compared to Xpert MTB/RIF: WHO/HTM/TB/2017.4. Geneva: World Health Organization, 2017. http://apps.who.int/iris/handle/10665/254792.
10. Davis A, Meintjes G, Wilkinson RJ. Treatment of tuberculous meningitis and its complictions in adults. Curr Treat Options Neurol, 2018, 28, 20(3): 5.
11. 邱建東, 董正梁, 王鑫, 等. 結核性腦膜炎合并低鈉血癥 104 例臨床分析. 世界最新醫學信息文摘, 2018, 18(18): 126-127.
12. 唐思穎, 井歡, 王看然, 等. 結核性腦膜炎伴低鈉血癥的臨床特征分析. 重慶醫科大學學報, 2018, 43(6): 793-796.
13. 常占林. 結核性腦膜炎合并低鈉血癥 20 例分析. 西藏醫藥, 2017, 38(4): 19-20.
14. 張朋. 結核性腦膜炎的臨床特征及預后影響因素分析. 中西醫結合心腦血管病雜志, 2015, 13(15): 1778-1780.

West China Medical Journal

Immunological and molecular technology assisting diagnosis: clinical characteristics analysis of 152 cases of tuberculous meningitis in northern Guizhou

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