Tuberculous Meningitis-Mimicking Varicella-Zoster Meningitis.
Tuberculous Meningitis-Mimicking Varicella-Zoster Meningitis.
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DOI：
10.3947/ic.2017.49.2.123
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发表时间：
2017-06
影响因子：
4.2
通讯作者：
Kim SH
中科院分区：
文献类型：
--
作者：
Hong SI;Kim T;Jung J;Park SY;Chong YP;Lee SO;Choi SH;Kim YS;Woo JH;Lee SA;Kim SH
水痘-带状疱疹病毒（VZV）是无菌性脑膜炎最常见的病因之一。VZV脑膜炎最常见的表现有时与结核性脑膜炎（TBM）相混淆。因此，我们研究了VZV脑膜炎的临床表现与TBM的比较。所有诊断为VZV脑膜炎或TBM的成人患者均在韩国首尔的三级医院入组，为期8年。分析患者的临床特征和脑脊液（CSF）特征。79例VZV脑膜炎患者和24例TBM患者入组本研究。在79例VZV脑膜炎患者中，63例（80%）未接受经验性抗结核治疗（第1组），其余16例（20%）接受经验性抗结核治疗（第2组），而24例TBM患者（第3组）。第3组的精神状态改变、重症监护室（ICU）入院、神经系统后遗症、CSF蛋白水平和CSF腺苷脱氨酶水平有高于第2组的趋势，第2组高于第1组。然而，第3组的CSF/血清葡萄糖比值显著低于第1组或第2组。大约五分之一的VZV脑膜炎病例表现为严重的表现，类似于TBM。脑脊液/血清葡萄糖比值可能有助于区分VZV脑膜炎和TBM，直到有明确的诊断试验。医生应该记住，需要对严重的VZV脑膜炎和TBM进行鉴别诊断。
Varicella-zoster virus (VZV) is one of the most common etiologies of aseptic meningitis. The severest manifestation of VZV meningitis is occasionally confused with tuberculous meningitis (TBM). Thus, we investigated the clinical manifestations of VZV meningitis as compared with those of TBM. All adult patients who were diagnosed with VZV meningitis or TBM were enrolled at a tertiary hospital in Seoul, South Korea, during an 8-year period. The clinical characteristics and cerebrospinal fluid (CSF) profile of patients were analyzed. Seventy-nine patients with VZV meningitis and 24 patients with TBM were enrolled in this study. Of the 79 patients with VZV meningitis, 63 (80%) did not received empirical anti-tuberculous therapy (Group 1) and the remaining 16 (20%) received empirical anti-tuberculous therapy (Group 2), compared with 24 patients with TBM (Group 3). Altered mental status, intensive care unit (ICU) admission, neurologic sequelae, CSF protein levels, and CSF adenosine deaminase levels revealed a trend of being higher in Group 3 than Group 2, which was higher than Group 1. However, the CSF/serum glucose ratio was significantly lower in Group 3 than in Group 1 or Group 2. About one fifth of VZV meningitis cases presented as severe manifestations, mimicking TBM. The CSF/serum glucose ratio might be useful to differentiate VZV meningitis from TBM until definite diagnostic tests are available. Physicians should keep in mind that a differential diagnosis between severe VZV meningitis and TBM is needed.