Tuberculous meningitis in south African urban adults
Tuberculous meningitis in south African urban adults
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DOI：
10.1093/qjmed/91.11.743
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发表时间：
1998-11-01
影响因子：
13.3
通讯作者：
Crewe-Brown, HH
中科院分区：
文献类型：
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作者：
Karstaedt, AS;Valtchanova, S;Crewe-Brown, HH
我们回顾性分析了56例经细菌培养证实的结核性脑膜炎（TBM）患者的临床体征、脑脊液（CSF）检查结果和预后。50例患者，年龄18-59岁，39例有人类免疫缺陷病毒（HIV）感染，11例无HIV感染。6人年龄在60岁或以上。18-59岁人群中TBM的神经系统体征不受HIV血清状态的影响，而与≥ 60岁人群相比，脑膜炎患者更多（86.0% vs. 33.30%; p=0.011），癫痫发作患者更少（12.0% vs. 50.0%; p=0.046）。与非HIV感染者相比，HIV感染者（18-59岁）的脑膜外结核明显更多（76.9% vs. 9.1%; p = 0.0001），23.1%有“突破性”TBM。CSF分析显示12例患者（21.4%）存在无细胞液体（在≥ 60岁的患者中更常见，p 0.016），其中3例患者的CSF完全正常。中性粒细胞占优势的22例（39.3%）。只有3名患者（5.4%）的脑脊液涂片抗酸杆菌阳性。39例患者（69.1%）发生院内死亡，所有研究组的死亡率相似，与神经系统分期无关。由于老年人没有脑膜炎和脑脊液表现不典型，可掩盖结核性脑膜炎的诊断。
We retrospectively reviewed 56 adults with culture-proven tuberculous meningitis (TBM), investigating clinical signs, cerebrospinal fluid (CSF) findings and outcome. There were 50 patients, aged 18-59 years, 39 with and 11 without human immunodeficiency virus (HIV) infection. Six were aged 60 years or older. Neurological signs of TBM in 18-59-year-olds were unaffected by HIV serostatus while, compared to those greater than or equal to 60 years of age, there were more patients with meningism (86.0% vs. 33.30%; p=0.011) and fewer with seizures (12.0% vs. 50.0%; p=0.046). The HIV-infected 18-59-year-olds had significantly more extrameningeal tuberculosis compared to the non-HIV-infected (76.9% vs. 9.1 %; p = 0.0001) and 23.1% had 'breakthrough' TBM. CSF analysis revealed 12 patients (21.4%) with acellular fluid (more common in those greater than or equal to 60 years of age, p 0.016), of whom three had completely normal CSF. A neutrophil predominance was found in 22 patients (39.3%). Only three patients (5.4%) had a positive CSF smear for acid-fast bacilli. In-hospital mortality occurred in 39 patients (69.1%), was similar in all study groups, and was not related to neurological stage. The diagnosis of TBM can be masked by lack of meningism in the elderly and by atypical CSF findings.