Neuro-meningeal Tuberculosis in Adult Senegalese Patients: Profile and Outcome of Cases Diagnosed at a Referral Service, from 2015 to 2020

Background: Among patients treated for tuberculosis, 2% to 5% have a Central Nervous System (CNS) lesion, and its frequency rises to 10% in HIV-infected patients. Neuro-meningeal tuberculosis (NMT) is responsible for death and severe permanent neurological damage. This poor prognosis requires early diagnosis and rapid initiation of specific treatment. Unfortunately, the great clinical polymorphism and the lack of specificity of radiological and biological signs are frequently responsible for a delay in diagnosis and management. Senegal is one of the African countries where tuberculosis has remained a concern until now. And there are no studies carried out on this subject. Objective: The objective of this study was to describe the profile and outcome of Neuro-meningeal tuberculosis (NMT) cases diagnosed at the infectious diseases department (SMIT) of Fann University Hospital in Dakar, (referral service for management of tuberculosis). Methods: We carried out a retrospective, descriptive and analytical study, reviewing medical records of adults diagnosed with NMT at the SMIT of Fann Hospital from January 2015 to December 2020. Results: We collected 55 cases of NMT. The median age was 38 years [range 16 - 77 years]. The sex ratio (M/F) was 3.23. HIV patients represented 41.82% of cases. A history of tuberculosis was found in 25.5% of cases. The delay in consultation was greater than one month in 60% of patients. Headaches were the most constant reason for consultation (94.55%). Meningeal signs were present in 94.55% of patients, and consciousness disorders and intracranial hypertension were present in 63.64% and 56.36% respectively. Nerve palsy was found in 38.18%. CSF was clear in 81.64%. GeneXpert MTB/RIF in CSF was performed in 33 patients and was positive in 4 patients. Brain CT was abnormal in 72.09% of cases. Tuberculoma, hydrocephalus and meningeal contrast enhancement were the main lesions. The neuro-meningeal localization was associated with a pulmonary form in 32.7%. The lethality rate was 21.8%;higher in women (46.2% vs 14.3%;p = 0.01), in patients with a delay in consultation > 1 month (p = 0.03), and in patients who presented with consciousness disorders (p = 0.007). Conclusion: Despite the availability of the GeneXpert MTB/RIF, diagnosis of NMT remains difficult. Because of its variable clinical expression and the low sensitivity of the GeneXpert MTB/rif in the CSF, it exposes patients to serious complications. Among the factors associated with death, we found consciousness disorders, a long delay in diagnosis.

Disseminated tuberculosis presenting as meningitis and spondylodiscitis in an immunocompetent adult

Rationale:Disseminated tuberculosis involves the central nervous system in up to a third of cases.However,meningitis and spondylodiscitis due to miliary tuberculosis rarely occur together,particularly in the immuno-competent population.Patient concerns:A 37-year-old immunocompetent male presented with altered level of consciousness for one week and lower back pain with evening pyrexia for one month.Examination revealed spastic paraplegia and left hemiparesis.Diagnosis:Disseminated tuberculosis presenting with meningitis and spondylodiscitis.Interventions:Category I anti-tuberculous therapy with a tapering regimen of intravenous dexamethasone was administered.Outcomes:There was clinical improvement after nine months of treatment.Lessons:Tuberculosis may present with atypical clinical manifestations.Contrast enhanced computed tomography scan or magnetic resonance imaging combined with histopathological features,a high index of suspicion and clinical improvement with anti-tuberculous treatment can confirm the diagnosis in the absence of microbiological evidence,especially in extrapulmonary tuberculosis.

psk1 virulence gene-induced pulmonary and systemic tuberculosis in a young woman with normal immune function:A case report

BACKGROUND Tuberculosis is a chronic infectious disease and an important public health pro-blem.Despite progress in controlling tuberculosis,the incidence of tuberculosis in China is still very high,with 895000 new cases annually.This case report des-cribes the investigation of a case of severe disseminated tuberculosis in a young adult with normal immune function,conducted to ascertain why a Mycobacterium tuberculosis(M.tuberculosis)strain caused such severe disease.CASE SUMMARY A previously healthy 28-year-old woman presented to our hospital with a 1-mo-nth history of fever and fatigue.She was diagnosed with severe disseminated pulmonary tuberculosis,spinal tuberculosis with paravertebral abscesses,and tuberculous meningitis.M.tuberculosis was isolated from bronchoal-veolar lavage fluid.She was treated with standard antituberculous therapy and underwent debridement,bone graft,and internal fixation surgery for spinal tuberculosis.She responded to therapy and regained her ability to walk following the surgery.We analysed the whole-genome sequence of the strain and designated it BLM-A21.Additional M.tuberculosis genomes were selected from the Virulence Factor Database(http://www.mgc.ac.cn/cgi-bin/VFs/genus.cgi?Genus=Mycobacterium)for comparison.An evolutionary tree of the BLM-A21 strain was built using PhyML maximum likelihood software.Further gene analysis revealed that,except for the pks1 gene,BLM-A21 had similar virulence genes to the CDC 1551 and H37Rv strains,which have lower dissemination.CONCLUSION We speculate that the pks1 virulence gene in BLM-A21 may be the key virulence gene responsible for the wide-spread dissemination of M.tuberculosis infection in this previously healthy adult with normal immune function.

Ischemic Stroke Complicating Neuromeningeal and Pulmonary Tuberculosis in Children: About a Case in Senegal

Tuberculosis is a major public health problem, especially in developing countries. Neuro-meningeal involvement is rare but represents one of the most severe forms with high morbidity and mortality. We report the case of an ischemic stroke complicating neuromeningeal and pulmonary tuberculosis in a four-month-old infant at the National Hospital Center of children Albert Royer (Senegal). The case was a four-month-old, male infant with no history. His vaccination was up to date according to Senegal’s expanded vaccination program. There was no notion of tuberculosis contagion. He was seen for a prolonged fever for more than a month and chronic cough. He had moderate malnutrition. Neurological examination revealed coma, meningeal syndrome, generalized tonic convulsions and hypertonia. The pupils were in bilateral miosis. Osteotendinous reflexes were abolished with a bilateral Babinski sign. He also had severe respiratory distress, bilateral pulmonary condensation syndrome. Brain computed tomography was in favor of an ischemic stroke. The test GeneXpert MTB/RIF was positive on cerebrospinal fluid and gastric tubing fluid. The curative treatment was based on a quadruple therapy based on rifampicin, isoniazid, pirazinamide and ethambutol. The evolution was unfavorable with the death of the patient.

Tuberculosis Meningitis Associated with Poncet’s Disease: A Rare Case in a Young Senegalese Patient

Described by Antonin Poncet in 1897, Poncet’s disease is a non-destructive (non-erosive) inflammatory arthritis secondary to a mycobacterial infection, without an identified infectious agent in the affected joints. Neuromeningeal localization of tuberculosis (TB) is rare but remains the most severe with hight mortality and permanent neurological damage. Association of Poncet’s rheumatism and TB is rare, even less a neuromeningeal localization. We report here a case of optic nerve compression syndrome complicating tuberculous meningitis associated with Poncet’s rheumatism characterized by a good outcome. This was an 18-year-old female with no reported pathological history, who was admitted for obnubilation. The symptoms started two weeks before her hospitalization and were marked by fever and headache. On admission, the examination revealed obnubilation, bilateral pyramidal deficit syndrome, right ptosis and areactive mydriasis predominating on the right, meningeal syndrome, and intense inflammatory polyarthralgia. The brain CT showed meningeal contrast enhancement with moderate dilatation of ventricles. GeneXpert MTB/rif in CSF was positive. Rheumatoid factors (latex and Waaler-Rose test) and anti-CCP antibodies were negative. Anti-nuclear, anti-native DNA and anti-NAS antibodies were negative. Ophthalmological examination revealed optic nerve compression syndrome associated with extrinsic and intrinsic oculomotor paralysis in the right eye. Orbito-encephalic MRI showed compression of the optic nerve, and hydrocephalus. Under antituberculosis treatment, we noticed disappearance of arthralgia in three weeks, regression of intracranial hypertension and improvement of vision.

Tuberculous meningitis and miliary tuberculosis in Iran:A review

In recent years,the number of cases of extrapulmonary tuberculosis in Iran has increased.The goal of this study was to determine the epidemiological status,clinical symptoms,diagnostic methods,and treatment strategies of extrapulmonary tuberculosis in Iran,with a focus on tuberculosis meningitis and miliary tuberculosis.Between January 1,2000 and June 1,2021,1651 cases of tuberculosis meningitis and miliary tuberculosis were discovered in Iran.The prevalence of tuberculosis meningitis was higher in Sistan and Baluchestan,South Khorasan,and Mazandaran compared with other provinces.The most prevalent symptoms of tuberculous meningitis were fever,anorexia,headache,neck stiffness,loss of consciousness,and vomiting.The most commonly used procedures for diagnosing tuberculous meningitis were polymerase chain reaction and cerebrospinal fluid culture.The most prevalent clinical symptoms of miliary tuberculosis were fever,lethargy,weariness,and anorexia.In 70%of chest radiographs,a miliary pattern was visible.Bone marrow biopsy was used to diagnose miliary tuberculosis in 80%of patients,while bronchoalveolar lavage was used in 20%of cases.The conventional 6-month treatment approach for tuberculous meningitis and miliary tuberculosis was used for all of the participants in the investigations.Given the high prevalence of extrapulmonary tuberculosis patients in Iran and the devastating consequences of the disease,the researchers recommend that further study be done to prevent extrapulmonary tuberculosis in the general population.

Significant risk and associated factors of active tuberculosis infection in Korean patients with inflammatory bowel disease using anti-TNF agents

AIM:To evaluate the incidence and risk factors of Korean tuberculosis(TB) infection in patients with inflammatory bowel disease(IBD) undergoing anti-TNF treatment.METHODS:The data of IBD patients treated with anti-TNFs in 13 tertiary referral hospitals located in the southeastern region of Korea were collected retrospectively.They failed to show response or were intolerant to conventional treatments,including steroids or immunomodulators.Screening measures for latent TB infection(LTBI)and the incidence and risk factors ofactive TB infection after treatment with anti-TNFs were identified.RESULTS:Overall,376 IBD patients treated with antiTNF agents were recruited(male 255,mean age of anti-TNF therapy 32.5±13.0 years);277 had Crohn’s disease,99 had ulcerative colitis,294 used infliximab,and 82 used adalimumab.Before anti-TNF treatment,screening tests for LTBI including an interferon gamma release assay or a tuberculin skin test were performed in 82.2%of patients.Thirty patients(8%)had LTBI.Sixteen cases of active TB infection including one TB-related mortality occurred during 801 personyears(PY)follow-up(1997.4 cases per 100000 PY)after anti-TNF treatment.LTBI(OR=5.76,95%CI:1.57-21.20,P=0.008)and WBC count<5000 mm3(OR=4.5,95%CI:1.51-13.44,P=0.007)during follow-up were identified as independently associated risk factors.CONCLUSION:Anti-TNFs significantly increase the risk of TB infection in Korean patients with IBD.The considerable burden of TB and marked immunosuppression might be attributed to this risk.

Analytical Optimization of GeneXpert Ultra for Detection of Tuberculosis in CSF Samples

Detection of Mycobacterium tuberculosis complex (MTBC) in extrapulmonary specimens can be challenging due to their paucibacillary nature. This difficulty is especially true for cerebrospinal fluid (CSF), and the low sensitivity and specificity for diagnosis hampers rapid detection and treatment in vulnerable populations. GeneXpert MTB/RIF Ultra has been shown to provide rapid results for detection of MTBC and associated Rifampin resistance, but there is limited data regarding standardized methods for CSF processing on this assay. In this study, we sought to provide guidance regarding the best methods for CSF processing, including optimal volumes to test, length of incubation with sample reagent and finally effects of long-term freezing on detection.

Predictors of cerebrospinal fluid GeneXpert MTB/RIF positivity in patients with tuberculous meningitis:A prospective cohort study

Objective:To identify the clinical,laboratory,and radiological markers that could predict a positive GeneXpert result in patients suspected of tuberculous meningitis.Methods:In this prospective,observational study,patients with tuberculous meningitis were systematically evaluated.Various clinical,laboratory[including cerebrospinal fluid(CSF)microscopy,culture,and GeneXpert],and neuroimaging factors were examined.All participants were administered anti-tuberculous treatment and corticosteroids.A six-month follow-up was done to evaluate the outcome.Results:Of the 116 patients studied,54(46.6%)tested positive for GeneXpert,while 62(53.4%)were negative.Third cranial nerve involvement(OR 3.71,95%CI 1.052-13.09,P=0.04)and the presence of basal exudates on neuroimaging(OR 5.22,95%CI 2.03-13.42,P=0.001)emerged as independent predictive factors for a positive GeneXpert result.A positive CSF GeneXpert result(P=0.002)and drug resistance(P=0.004)were significantly linked to adverse outcomes.Additionally,a high score on the Medical Research Council stageⅢ(OR 5.64,95%CI 1.18-26.87,P=0.03)and elevated CSF cell counts(OR 1.002,95%CI 1.00-1.001,P=0.03)were identified as independent predictors of poor prognosis.Conclusions:Third cranial nerve involvement and the presence of basal exudates were significant indicators of a positive GeneXpert result.MRC stageⅢdisability and elevated CSF cell counts predicted poor outcomes.

Association of immunophenotypic characterization of peripheral lymphocytes with different clinical phenotypes of tuberculosis in Chinese Han children

Background Very few researchers have studied the changes in peripheral lymphocyte patterns in adult tuberculosis （TB） and even less researches have been conducted in pediatric TB.In this study,we obtained blood samples from 114 Chinese pediatric TB patients and 116 matched controls to study the association of phenotypic subsets of peripheral lymphocytes with different clinical phenotypes of TB.Methods The subjects were classified as the control group and the TB patients group which were further divided into a pulmonary TB group and an extra-pulmonary TB group （more serious than the former）.The distribution of lymphocyte subpopulations,including T lymphocytes,CD4＋ T lymphocytes,CD8＋ T lymphocytes,B lymphocytes,and natural killer （NK） cells,were quantitatively analyzed by flow cytometry.Results Compared to the healthy controls,TB infection was associated with significantly higher B cell （P 〈0.0001）,and lower T cell （P=0.029） and NK cell （P 〈0.0001） percentages.Compared to pulmonary TB patients,extra-pulmonary TB was associated with relatively higher B cell （P=0.073）,and lower T cell percentages （P=-0.021）,higher purified protein derivative （PPD） negative rate （P=-0.061）,and poorer PPD response （P=-0.010）.Most pulmonary TB cases were primary pulmonary TB （89.1%）,and most extra-pulmonary TB cases had TB meningitis （72.1%）.Conclusions This study demonstrates changes in the lymhocyte distribution in children suffering from different clinical phenotypes of TB; such as primary pulmonary TB,and TB meningitis.These patterns may have significance in understanding the pathogenesis and prognostic markers of the disease,and for developing immunomodulatory modalities of therapy.

C-di-GMP signaling and implications for pathogenesis of Mycobacterium tuberculosis

C-di-GMP is a ubiquitous bacterial second messenger that regulates a wide range of bacterial physiological processes including biofilm formation, virulence, motility and cell differentiation. Here, we have summarized our current knowledge on the upstream signaling factors and downstream effectors of c-di-GMP in addition to the interaction between c-di-GMP and eukaryotic organisms. New discoveries in these areas have enriched our understanding of the diversity of c-di-GMP signaling pathways and provide important clues for us to explore the roles of c-di-GMP signaling in human pathogens such as Mycobacterium tuberculosis.

Diagnosis of disease-specific proteins in cerebrospinal fluid of children infected with tuberculous meningitis

BACKGROUND： Isolated mycobacterium tuberculosis from cerebrospinal fluid （CSF） is regarded as the ＂gold standard＂ for diagnosis of tuberculous meningitis （TBM）. However, culture of CSF specimens is time-consuming and lacks sensitivity. There is a strong need to determine complementary disease-specific markers, which are essential for increasing early diagnosis and improving prognosis in patients with TBM OBJECTIVE： To establish proteomic profiles of CSF in TBM and normal children using two-dimensional polyacrylamide gel electrophoresis, and to screen for disease-specific proteins. DESIGN, TIME AND SETTING： The case-control study was conducted at the Department of Pediatrics, Xiangya Hospital of Central South University and the Key Laboratory of Cancer Proteomics of Ministry of Public Health of China between January 2008 and January 2009. PARTICIPANTS： The TBM group included three patients with a strongly positive tuberculin skin test, as well as positive CSF mycobacterial staining and culture, who were admitted to the Department of Pediatrics, Xiangya Hospital from January 2008 to January 2009. Three healthy, age- and gender-matched children served as the control group. METHODS： CSF proteins were separated using two-dimensional polyacrylamide gel electrophoresis in both groups. Gels were scanned using Image scanner and LabScan software. Differentially expressed proteins were analyzed using PDQuest 7.0 software. The clearly discernible spots, which were expressed only in the TBM group, were chosen to perform matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis. MAIN OUTCOME MEASURES： Differentially expressed spots on CSF profiles of TBM and normal children were measured. RESULTS： Following comparison of two-dimensional polyacrylamide gel electrophoresis maps between TBM and control groups, 546 and 533 spots were detected, respectively. A total of 64 differentially expressed proteins were observed between the groups, including 15 upregulated spots, eight downregulated spots, 27 spots that were exclusively expressed in the TBM group, and 14 spots that were exclusively expressed in the control group. At total of 20 spots that were exclusively expressed in the TBM group were chosen for matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis, and 20 peptide mass fingerprints were obtained. After searching the data base, 16 proteins were matched. CONCLUSION： Two-dimensional polyacrylamide gel electrophoresis profiles of the CSF proteome were successfully established in the TBM and normal children. Parts of these differentially expressed proteins were identified through mass spectrometry and bioinformatics. Results indicated that apolipoprotein A I, anti-tumor necrosis factor-alpha antibody, crystal structure of MRP14 and HLA class II histocompatibility antigen DRB1-4 could be closely correlated with TBM pathogenesis.

貌似结核性脑膜炎的系统型ALK阴性间变性大细胞淋巴瘤临床分析

目的报道1例首发症状表现为脑膜炎的系统型间变性大细胞淋巴瘤(ALCL)的诊治经过,以加深对该类疾病的认识。方法分析1例表现为发热、头痛、颅压升高,曾疑诊为结核性脑膜炎的系统型淋巴瘤激酶(ALK)阴性系统型ALCL患者的临床表现与诊治经过。结果本例患者38岁男性,以头痛、持续颅内压升高为突出表现,同时伴有发热、体质量下降、淋巴结增大等全身症状、脑脊液白细胞数量和蛋白含量增高、葡萄糖下降,给予抗病毒、抗结核治疗后病情仍反复,最终通过颈部淋巴结活检,诊断为系统型ALK阴性ALCL。结论系统型ALK阴性ALCL以脑部病变为首发症状者误诊率高,对于不符合常见神经系统疾病病程和转归特点,伴有发热、体质量下降、淋巴结肿大者,应考虑到淋巴瘤可能,积极行病理检查,争取早期诊断,改善患者预后。

Extra-Pulmonary Pott’s Disease with Intracranial Manifestations: An Inmate’s Story

Tuberculosis is a chronic disease that is the leading cause of infectious disease deaths worldwide. In developed countries, incidences are minimal and however, complicated manifestations of tuberculosis are becoming a trend within the prison system. This case report illustrates a patient within the United States correctional system who demonstrated a rare infection of tuberculosis despite absent pulmonary findings. Our Patient was a 39-year-old inmate presenting with fatigue, night sweats, weight loss, and progressive dyspnea. Pulmonary imaging and cultures of sputum were negative for tuberculosis. Further imaging and laboratory workups demonstrated extensive spinal infections along with intracranial lesions that were positive for tuberculosis. Neurosurgery declined operative medicine due to advancement of the disease and appropriate antibiotic therapy was immediately initiated. Tuberculosis continues to exist in developed countries with an increased emergence of complicated cases. Furthermore, incarceration dramatically increases an individual’s risk of worse infections. The clinical impact involves promoting awareness for a need to identify and prevent continued spread of disseminated infections. Therefore, further investigations of this trend in prisons are worth considering.

脑脊液特征指标辅助结核性脑膜炎快速筛查的效果评估

目的:探索利用若干脑脊液特征指标辅助提高敏感度,实现结核性脑膜炎(tuberculous meningitis,TBM)的快速筛查和早期治疗控制。方法:2011—2019年期间,依据纳入排除标准,从江苏省苏州市、四川省自贡市和贵州省贵阳市的结核病定点医疗机构收治的383例疑似TBM患者中,随机筛选100例临床诊断TBM患者,并按年龄、性别1∶1配对抽取100例非TBM患者,收集脑脊液白细胞计数、乳酸盐、蛋白总量、腺苷脱氨酶、葡萄糖等生化指标,并采用超高通量液相色谱法分离患者脑脊液代谢物,通过偏正交最小二乘判别法分析(OPLS-DA)筛选在不同类型患者中分布具有差异的生化和代谢物指标,通过机器学习构建决策树模型(boosted-CART),评估特征指标对于快速筛查各类型TBM患者的效果。结果:以P<0.05、OPLS-DA模型变量权重值>1和代谢物组间表达量差异倍数>1为标准,利用boosted-CART模型筛选脑脊液L-谷氨酰胺和葡萄糖水平作为特征指标,其cut-off值分别为607.06mmol/L(L-谷氨酰胺)和60.03mg/dl(葡萄糖)。上述两项指标联用,可将检出很可能和可能TBM患者的敏感度从66.7%(95%CI:24.1%~94.0%)提升至83.3%(95%CI:36.5%~99.1%),AUC值从0.667(95%CI:0.444~0.889)提升至0.708(95%CI:0.494~0.923),但效果不明显(Z=0.261,P>0.05)。结论:脑脊液L-谷氨酰胺和葡萄糖指标可提高TBM快速筛查的敏感度,利于TBM早诊早治和控制结核病传播。

低剂量沙利度胺辅助治疗20例成人结核性脑膜炎矛盾反应的临床分析

目的:分析低剂量沙利度胺辅助治疗成人结核性脑膜炎(tuberculous meningitis,TBM)矛盾反应的临床疗效和安全性。方法:选取2020年1月1日至2022年12月30日长春市传染病医院收治的符合TBM矛盾反应诊断标准的患者共20例进行回顾性研究。20例患者均在不调整原有糖皮质激素用量及抗结核治疗方案的前提下,口服沙利度胺25 mg(4次/d)治疗。分析患者应用沙利度胺后临床症状转归、脑脊液参数变化、影像学表现及药物不良反应。结果:20例患者中,14例(70.0%)出现新发结核瘤,11例(55.0%)原有结核瘤病变恶化、10例(50.0%)脑池渗出增多,5例(25.0%)新发脑梗死。经沙利度胺治疗后,14例新发结核瘤及11例原有结核瘤恶化的患者,病灶明显好转,≤3 mm的结核结节可完全吸收,>3 mm的结核结节可表现为完全吸收或病灶范围缩小;10例脑池渗出增多的患者,病灶明显消退。5例脑梗死患者,无进展性卒中发生,梗死周围水肿明显消退并形成软化灶。17例脑脊液异常患者中,8例脑脊液白细胞计数恢复正常,9例脑脊液参数好转稳定。沙利度胺中位治疗时间为16(12,16)周。全部患者均在颅内病变明显好转或脑脊液指标好转稳定后,停用沙利度胺。治疗期间,2例患者出现末梢神经炎,给予营养神经治疗后好转,无其他可归因于沙利度胺的不良事件报告。结论:低剂量沙利度胺辅助治疗结核性脑膜炎矛盾反应,可有效改善患者颅内病变及脑脊液参数,且安全性较好。

儿童结核性脑膜炎合并营养不良的临床特征及与短期转归的关系

目的探讨儿童结核性脑膜炎(TBM)合并营养不良的临床特征及与TBM短期转归的关系。方法回顾性选取2016年2月至2022年4月广州市胸科医院儿科收治的80例TBM患儿作为研究对象,根据营养不良诊断标准将患儿分为营养不良组(66例)和非营养不良组(14例)。营养不良组男35例,女31例;1月龄~<1岁6例,1~<3岁19例,3~<6岁11例,6~<18岁30例;生活环境:村镇64例,城市2例。非营养不良组男9例,女5例;1月龄~<1岁1例,1~<3岁3例,3~<6岁2例,6~<18岁8例;生活环境:村镇7例,城市7例。对比分析两组临床特征及与短期转归的关系。采用χ^(2)检验和Fisher确切概率法。结果在80例TBM患儿中,82.5%(66/80)合并营养不良,71.2%(57/80)合并贫血,51.2%(41/80)合并低蛋白血症。营养不良组居住在村镇[97.0%(64/66)]、病程>14 d[81.2%(52/66)]的比例高于非营养不良组[50.0%(7/14)、35.7%(5/14)](均P<0.05)。营养不良组贫血[77.2%(51/66)]、低蛋白血症[57.6%(38/66)]、药物性肝损伤[51.5%(34/66)]、后遗症发生率[48.5%(32/66)]和出院时脑脊液异常率[60.6%(40/66)]均高于非营养不良组[42.8%(6/14)、21.4%(3/14)、21.4%(3/14)、14.3%(2/14)、35.7%(5/14)](均P<0.05)。两组临床分期、脑积水、脊髓病灶、病死率比较,差异均无统计学意义(均P>0.05)。结论TBM患儿易合并营养不良,营养不良的TBM患儿易出现短期转归不良,有必要尽早对TBM患儿进行营养风险筛查及营养支持治疗。

Xpert MTB/RIF联合T-SPOT.TB对结核性脑膜炎的早期诊断价值

目的探讨利福平耐药实时荧光定量核酸扩增技术(Xpert MTB/RIF)联合结核感染T细胞斑点试验(TSPOT.TB)对结核性脑膜炎早期诊断的临床价值。方法收集2019年10月至2022年9月于河南省胸科医院就诊的疑似结核性脑膜炎患者90例,经确诊分为脑膜炎组(46例)和非脑膜炎组(44例)。所有研究对象进行脑脊液抗酸杆菌涂片、脑脊液Xpert MTB/RIF和外周血T-SPOT.TB检测,比较各单一检测方法和联合检测的诊断阳性率、阴性率和准确率,采用灵敏度、特异度、阳性预测值、阴性预测值和受试者工作特征曲线对各检测方法的诊断价值进行评价。结果TSPOT.TB和Xpert MTB/RIF单一检测诊断阳性率(分别为69.57%和60.87%)均高于涂片抗酸染色(19.57%),TSPOT.TB与Xpert MTB/RIF并联检测诊断阳性率(89.13%)高于串联检测(60.87%)和所有单一检测方法,差异有统计学意义(P<0.05)。并联检测诊断准确率(90.00%)高于串联检测(78.89%)和Xpert MTB/RIF检测(77.78%),差异有统计学意义(P<0.05)。并联检测对结核性脑膜炎诊断的灵敏度和阴性预测值达到89.13%和88.89%,均高于串联检测和单一检测方法;特异度和阳性预测值分别为90.91%和91.11%,与串联检测和单一检测方法差异无统计学意义(P>0.05);曲线下面积最高,达到0.900(95%CI:0.828~0.972)。结论TSPOT.TB与Xpert MTB/RIF检测用于结核性脑膜炎诊断,相比较传统方法具有较好的敏感度和特异度,采取并联检测方式能够显著提高结核性脑膜炎的诊断效能,有利于早期诊断和治疗。

Concurrent tubercular and staphylococcus meningitis in a child

Spontaneous,non-surgical haematogenous Staphylococcus aureus meningitis is rare and associated with high mortality.Mixed infection causing meningitis(pyogenic and tubercular) is further rarer,poses a difficult diagnostic and management challenge,which warrants early diagnosis and aggressive therapy.We present a case of concurrent pyogenic and tubercular meningitis in a child managed successfully.It seems that in present case initial pyogenic infection resulted in the immunocompromised state for the child that would had lead to the activation of tubercular foci resulting in tubercular meningitis.

A Rare Case of Tubercular Cholesteatoma with TB Meningitis

Tubercular otitis media is an uncommon condition. Tuberculosis can affect any part of ear ranging from tympanic membrane to labyrinth. The symptoms of tubercular otitis media like painless otorrhea, multiple perforations, pale granulations, facial paralysis and severe SNHL though well described in literature, are not always present hence diagnosis is often missed. Diagnosis is usually made by clinical and histopathology examination of specimen obtained intra operatively. Here, we discuss clinical presentation, diagnosis and management of a case with cholesteatoma and TB meningitis.