Table 3.
The summary of basal clinical features in 24 patients with suspected TBM.
| Patient No. | Age/Sex | *Clinical stage | Basal CSF findings (before treatment) | Single PCR assay |
Nested PCR assay |
WR-QNRT-PCR assay) (copies/mL CSF) |
Cranial MRI findings |
M.Tb outside CNS | Period up to initial sample collection | ATT responsE | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Cells (/μL) | Protein (mg/dL) | Glucose (mg/dL) |
ADA (IU/L) | AFB smear | M.Tb culture | ||||||||||
| Confirmed cases | |||||||||||||||
|
| |||||||||||||||
| 1 | 73/M | III | 288 | 299 | 13 | 23.4 | − | + | + | + | 28721 | ME, HC, CVD, IFM | Sp, GA | About 3 weeks | Noneffective |
| 2 | 76/M | III | 165 | 569 | 46 | 12.3 | − | + | + | + | 10028 | ME, CVD | Sp | 2 days | Effective |
| 3 | 28/M | III | 605 | 434 | 25 | 16.3 | − | + | − | + | 22571 | ME, HC, CVD, IFM | Sp | About 1 month | Noneffective |
| 4 | 38/M | II | 76 | 637 | 18 | 6.5 | − | + | − | + | 7161 | HC, IFM | Sp, GA | 1 day | Effective |
| 5 | 53/F | III | 344 | 354 | 38 | 10.3 | − | + | + | + | 4547 | IFM | − | 1 day | Effective |
| 6 | 72/F | III | 247 | 329 | 57 | 18.4 | − | + | − | + | 6340 | HC, IFM | − | 7 days | Noneffective |
| 7 | 34/M | II | 612 | 320 | 18 | 20.2 | − | + | + | + | 1243 | − | − | Not available | Effective |
| 8 | 42/M | II | 418 | 456 | 36 | 22.6 | − | + | + | + | 10532 | ME, IFM | Sp | About 2 weeks | Effective |
|
| |||||||||||||||
| Highly probable cases | |||||||||||||||
|
| |||||||||||||||
| 9 | 35/F | II | 208 | 300 | 13 | 16.3 | − | − | − | + | 7892 | ME, HC, CVD, IFM | − | 7 days | Effective |
| 10 | 65/F | I | 107 | 70 | 48 | 7.8 | − | − | − | + | 1904 | − | − | 3 days | Effective |
| II | 52/M | II | 18 | 135 | 54 | 8.6 | − | − | − | + | 5858 | ME, HC, CVD, IFM | Sp, GA | 1 day | Effective |
| 12 | 24/F | I | 30 | 25 | 30 | 4.4 | − | − | − | + | 5436 | IFM | − | 1 day | Effective |
| 13 | 44/F | III | 60 | 70 | 52 | N.D. | − | − | − | + | 9600 | CVD | − | 1 day | Effective |
| 14 | 59/F | II | 40 | 359 | 78 | 3.7 | − | − | − | + | 5112 | HC | − | About 1 month | Effective |
| 15 | 44/M | III | 117 | 87 | 48 | 3.9 | − | − | − | + | 8400 | ME | Sp, GA | About 3 weeks | Noneffective |
| 16 | 40/M | III | 800 | 188 | 66 | 12 | − | − | − | + | 7050 | CVD | − | 1 day | Effective |
| 17 | 30/F | III | 720 | 211 | 50 | 9.7 | − | − | − | + | 5596 | IFM | − | 5 days | Effective |
| 18 | 20/F | II | 442 | 164 | 46 | 17.6 | − | − | − | − | Not detected | IFM | GA | Not available | Effective |
| 19 | 63/M | III | 75 | 84 | 47 | 15.9 | − | − | − | − | 76 | ME | Sp | Not available | Effective |
| 20 | 63/F | II | 34 | 294 | 30 | 12.7 | − | − | − | + | 188 | HC | − | Not available | Effective |
| 21 | 53/M | III | 76 | 81 | 82 | 16.9 | − | − | − | + | 2592 | ME, IFM | Sp | 1 day | Effective |
| 22 | 51/M | III | 227 | 155 | 34 | 12.7 | − | − | − | + | 636 | ME, CVD, IFM |
− | 1 day | Effective |
| 23 | 66/M | III | 129 | 120 | 58 | 4.7 | − | − | − | + | 1600 | ME | − | 4 day | Effective |
| 24 | 2/F | II | 193 | 119 | 30 | 8.3 | − | − | − | + | 1444 | ME, HC | − | Not available | Effective |
(a) The clinical criteria suggestive for TBM are fever, headache, and neck stiffness of more than 1-week duration.
(b) supporting evidence for TBM include (1) compatible abnormal CSF findings that included increased white cell counts with lymphocytes predominating, c -hypoglycorrhachia, protein concentration >100 mg/dL, adenosine deaminase (ADA) ≧10 IU/L and negative results for routine bacterial and fungal cultures; (2) magnetic resonance imaging (MRI) findings suggesting tuberculous involvement of the CNS (basal exudates, hydrocephalus and intracranial focal mass, etc.); (3) presence of tuberculosis in the body outside of the CNS or a history of tuberculosis; (4) clinical response to antituberculosis therapy.
The suspected TBM cases were classified as “confirmed” cases (having the bacterial isolation for M.Tb such as CSF culture positive) or “highly probable” cases (meeting all the above clinical criteria and with all three supporting evidences positive).
*According to the clinical stages defined by the British Medical Research Council: stage 0: no definite neurologic symptoms, stage I: slight signs of meningeal irritation with slight clouding of consciousness, stage II: moderate signs of meningeal irritation with moderate disturbance of consciousness and neurologic defects, stage III: severe disturbance of consciousness and neurologic defects.
CSF: cerebrospinal fluid, PCR: polymerase chain reaction, TBM: tuberculous meningitis, M.Tb: Mycobacterium tuberculosis, ADA: adenosine deaminase, CNS: central nervous system, ME: meningeal enhancement, HC: hydrocephalus, CVD: cerebrovascular disorder, IFM: intracranial focal mass, Sp: sputum, GA: gastric aspirate, ATT: anti-tuberculosis treatment.