Tubercular Meningitis: The chronic disease with its emergent foot!
Journal Title: International Journal of Medical Science and Diagnosis Research (IJMSDR) - Year 2018, Vol 2, Issue 3
Abstract
Context: Tubercular meningitis; the most feared complication of tuberculosis poses significant diagnostic challenges and has a high morbidity and mortality. Aims: To evaluate clinical, laboratory and radiological parameters in patients with suspected tubercular meningitis. Settings and Design: This was a cross sectional observational study conducted in a tertiary care health centre in New Delhi, India from 2012-2015. Material and Methods: Patients ≥ 18 years of age, with a diagnosis of tubercular meningitis according to Marais’ case definition criteria underwent detailed history, clinical examination, CSF analysis, culture, Real time polymerase chain reaction, Amplified Mycobacterium tuberculosis Direct Testing and appropriate radiological studies. Statistical analysis: The correlation between quantitative variables was carried out by Pearson’s correlation coefficient (r) / non-parametric Spearmen’ rank correlation (ρ) with its statistical significance determined by t test. The qualitative variables were analysed by Student’s t-test/ non-parametric Man Whitney’s test and the association assessed by chi- square test / Fischer exact test. Results: Out of 50 patients in this study definite diagnosis of TBM could be made in 74% patients. The sensitivities of ZN staining, culture, AMTDT and RT- PCR in CSF were 15.8%, 31.6%, 53.9%, and 73.7% for diagnosing definite TBM with respect to BacT/Alert as the gold standard while the sensitivities were 8.1%, 19%, 89.2%, 62.7% respectively using Marais’ case definition as the gold standard. Conclusions: This study emphasizes that no single test can definitively rule out TBM. Thus, any suspected patient of TBM should undergo multiple tests to establish an early diagnosis. Key-words:-Tubercular meningitis, Marais’ criteria, Medical Research Council. Context: Tubercular meningitis; the most feared complication of tuberculosis poses significant diagnostic challenges and has a high morbidity and mortality. Aims: To evaluate clinical, laboratory and radiological parameters in patients with suspected tubercular meningitis. Settings and Design: This was a cross sectional observational study conducted in a tertiary care health centre in New Delhi, India from 2012-2015. Material and Methods: Patients ≥ 18 years of age, with a diagnosis of tubercular meningitis according to Marais’ case definition criteria underwent detailed history, clinical examination, CSF analysis, culture, Real time polymerase chain reaction, Amplified Mycobacterium tuberculosis Direct Testing and appropriate radiological studies. Statistical analysis: The correlation between quantitative variables was carried out by Pearson’s correlation coefficient (r) / non-parametric Spearmen’ rank correlation (ρ) with its statistical significance determined by t test. The qualitative variables were analysed by Student’s t-test/ non-parametric Man Whitney’s test and the association assessed by chi- square test / Fischer exact test. Results: Out of 50 patients in this study definite diagnosis of TBM could be made in 74% patients. The sensitivities of ZN staining, culture, AMTDT and RT- PCR in CSF were 15.8%, 31.6%, 53.9%, and 73.7% for diagnosing definite TBM with respect to BacT/Alert as the gold standard while the sensitivities were 8.1%, 19%, 89.2%, 62.7% respectively using Marais’ case definition as the gold standard. Conclusions: This study emphasizes that no single test can definitively rule out TBM. Thus, any suspected patient of TBM should undergo multiple tests to establish an early diagnosis. Key-words:-Tubercular meningitis, Marais’ criteria, Medical Research Council.
Authors and Affiliations
Mohindra Ritin
Keywords
Related Articles
- EP ID EP534321
- DOI -
- Views 64
- Downloads 0
AGE DETERMINATION FROM EPIPHYSEAL UNION OF BONES AT ANKLE JOINT IN GIRLS OF VALSAD DISTRICT
INTRODUCTION: There is an increasing demand or challenge for age estimations for both forensic and bioarchaeological contexts. Exact age of individuals can be obtained from only certified documents. The principal methods...
Type 1 Tympanoplasty- Impact of Perforation Size and Site on Closure and Audiological Improvement
Introduction: Tympanoplasty is the procedure of choice for the management of Chronic Suppurative Otitis Media of Tubotympanic type. Methods: Type 1 Tympanoplasty was done in 100 cases of chronic suppurative otitis media...
TO STUDY THE RELATION OF ASYMPTOMATIC CORONARY ARTERY DISEASE AND ASSOCIATED AUTONOMIC NEUROPATHY.
Background: This is a cross sectional study on the patients of type 2 diabetes mellitus without clinical and electrocardiographic evidence of coronary artery disease attending diabetic clinic, cardiology and medicine ou...
To study the role of x-ray in maxillofacial fractures diagnosis.
Background- Facial injury constitutes a frequent finding among emergency room patients. Methods- This study has been conducted in the Department of dental and radiology, on 30 patients with suspected maxillofacial fractu...
A COMPARATIVE EVALUATION OF FRACTURE STRENGTH OF INDIRECT COMPOSITE VENEERS, PRESSABLE VENEERS, CAD/CAM VENEERS AND NO PREPARATION VENEERS: AN IN VITRO STUDY.
Aim: The objective of the present study is to compare in vitro fracture strengths of indirect composite veneers, pressable veneers, CAD/ CAM veneers and no preparation veneers. Materials and Methods: Sixty extracted huma...