Objective To comprehensively observe, recognize, learn and understand the clinical features of tuberculous meningitis (TBM). Methods We retrospectively analyzed the general data, clinical manifestations, clinical examinations and treatment prognosis of 152 patients with TBM who were hospitalized in the Second Affiliated Hospital of Zunyi Medical College between January 2016 and February 2017. Results The mean age of the 152 patients with TBM was (43.9±20.4) years old, the ratio of male to female was 1.45:1, and the average length of hospital stay was (20.0±18.9) days. The clinical manifestations were mainly headache [95.4% (145/152)], nausea and vomiting [42.8% (65/152)], and fever [61.8% (94/152)]. The main co-morbidities were secondary pulmonary tuberculosis [52.0% (79/152)], hematogenous disseminated tuberculosis [37.5% (57/152)], and tuberculous pleurisy [30.9% (47/152)]. The positive rate of γ-interferon release test was 90.8% (129/142), and the brain pressure of lumbar puncture was elevated. The typical biochemical changes of cerebrospinal fluid were " low glucose, low chlorine, and high protein”. The positive rate of tuberculosis smear was extremely low, and the positive rate of GeneXpert MTB/RIF in cerebrospinal fluid was 21.9% (7/32). The TBM patiens were prone to combine with hypoproteinemia, the proportion reached 29.6% (45/152), and the proportion of hyponatremia reached 45.3% (69/152). Treated with early diagnosis and treatment, 92.1% (140/152) improved and discharged. Conclusions TBM patients are mainly young and middle-aged with various clinical manifestations and less respiratory symptoms; and are easy to be combined with pulmonary tuberculosis and other extrapulmonary tuberculosis. γ-interferon release test and cerebrospinal fluid GeneXpert MTB/RIF can be used for the auxiliary diagnosis of tuberculosis. Early detection, early diagnosis and treatment, rational and regular chemotherapy, strengthening symptomatic supportive treatment, and improving the precise diagnosis and treatment of TBM, can improve its clinical prognosis.
Objective To investigate the clinical manifestations,diagnosis and treatment of extensively drug-resistant tuberculosis (XDR-TB)meningitis. Methods One case of primary tuberculousis meningitis infected with multidrug-resistant mycobacteria was analyzed retrospectively.Relevant literatures were also reviewed by retrieving information through Wanfang Database and Pubmed using key words "multiple drug resistant tuberculosis meningitis","MDR tuberculosis meningitis","multiple drug resistant TBM","mul-drug resistant tuberculous meningitis","extensively drug resistant tuberculosis meningitis","XDR TBM","extensively drug resistant TBM" both in Chinese and English. Results A 24-year-old male patient,complained of headache,vomiting for 5 days,aggravated with mental abnormalities for 10 hours,with no history of pulmonary tuberculosis,was hospitalized in the Affiliated Hospital of Zunyi Medical College.The chest plain film was normal.Craniocerebral CT scan showed mild-hydrocephalus and cisterna ambiens stenosis.The patient died after undergoing anti-TB treatments with isoniazid(INH)0.3g iv qd,INH 0.3g po qd,rifampicin(RFP)0.45g qd,pyrazinamide(PZA)1.5g qd,ethambutol(EMB)0.75g qd,and dexamethasone(DEX)15mg qd.He was diagnosed as XDR-TB meningitis(as drug-resistant to isoniazid,rifampicin,streptomycin,ciprofloxacin,paminosalicylic acid,kanamycin,and protionamide ).Mycobacteria tuberculosis was isolated from his cerebrospinal fluid after 3 months.Five cases in 4 literatures were retrieved through Wanfang database and Pubmed among which 2 cases were initial treated,3 cases was unknown about initial treatment or re-treatment. Conclusions XDR-TB meningitis is rare in clinical practice with serious condition,rapid progress and high mortality rate.It is necessary to acquire drug susceptibility test results as soon as possible and adjust treatments according different conditions.A molecular drug susceptibility test may be helpful in the future.
Objective To investigate the clinical features of tuberculous meningoencephalitis.Methods The clinical characteristics and laboratory results of 126 cases who were diagnosed as tuberculous meningoencephalitis fromJanuary 2000 to April 2009 were analyzed retrospectively. Results The clinical manifestations of tuberculous meningoencephalitis included fever, headache, vomitting, hemiparalysis,paraplegia, mental anomaly, hypopsia, deafness, diplopia, muscular spasms, coma, and incomplete oculomotor palsy, etc. Vomitting which was characteristic symptom of tuberculous meningoencephalitis was found in 25 cases( 19. 8% ) . The diagnosis was confirmed more than eightweeks after the onset of the disease in 31 cases ( 24. 6% ) . The inhospital mortality rate of tuberculous meningoencephalitis was 14. 3% ( 18 /126) . The inhospital mortality rate of re-treatment patients was 42. 9% ( 6 /14) . In 41 patients with poor prognosis ( death or therapy failure) , 68. 3% ( 28/41) cases were complicated with military tuberculosis, which was higher than the overall occurrence of 41. 3% ( 52/126) . Conclusions Strict diagnostic criteria and atypicalsymptoms lead to delayed diagnosis, delayed treatment, and high mortality in patients with tuberculous meningoencephalitis, particularly in patients with military tuberculosis and re-treatment patients. There is still no effective treatment which have a significant impact on the prognosis.
Objectives We tended to evaluate the effectiveness of prophylactic antibiotics for preventing meningitis in patients with BSF. Method We searched the Cochrane Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to September 2005), EMBASE (1974 to June 2005), and LILACS (1982 to September 2005). We also performed an electronic search of meeting proceedings from the American Association of Neurological Surgeons (1997 to September 2005) and handsearched the abstracts of meeting proceedings of the European Association of Neurosurgical Societies (1995, 1999 and 2003). Randomized controlled trials (RCTs) comparing any antibiotic versus placebo or no intervention were identified. We also identified non-RCTs to perform a separate meta-analysis to compare results. At least two authors independently appraised the quality and extracted the data of each trial. Meta-analysis was conducted using RevMan 4.2 software. Results Five RCTs and 17 non-RCTs comparing different types of antibiotic prophylaxis with placebo or no intervention in patients with BSF were identified. Most trials presented insufficient methodological detail. All studies included meningitis in their primary outcome. Overall, we evaluated 208 participants from the four RCTs that were considered suitable for inclusion in the meta-analysis. There were no significant differences between antibiotic prophylaxis groups and control groups in terms of reduction of the frequency of meningitis, all-cause mortality, meningitis-related mortality, and need for surgical correction in patients with CSF leakage. We performed a subgroup analysis to evaluate the primary outcome in patients with and without CSF leakage. We also completed a meta-analysis of all the identified controlled non-RCTs (enrolling a total of 2 168 patients), producing results consistent with the randomised data. Conclusions Currently available evidence from RCTs does not support prophylactic antibiotic use in patients with BSF, whether there is evidence of CSF leakage or not. Until more research is completed, the effectiveness of antibiotics in patients with BSF cannot be determined because studies published to date are flawed by biases. Large, appropriately designed RCTs are needed.
Anthrax is a zoonotic, acute infectious disease caused by Bacillus anthracis. Anthrax meningitis is one of the most dangerous types of anthrax, mostly secondary to cutaneous, intestinal, and pulmonary anthrax, and is a central nervous system infectious disease that is extremely lethal in the absence of timely treatment. This article reviews the clinical characteristics, pathogenesis, diagnosis and treatment of anthrax meningitis, in order to provide some reference for the clinical diagnosis and treatment of anthrax meningitis in China, and to provide reference for the further development of anthrax meningitis research.
目的:分析结核性脑膜炎的临床及治疗中影响预后的因素。方法:回顾分析10 年来我院收治的68 例结核性脑膜炎患者的临床及实验室资料。结果:59 例患者痊愈,5 例患者遗留肢体后遗症,4 例患者死亡。结论:治疗结核性脑膜炎过程中积极区分引起低钠血症的原因及鉴别药物热与类赫氏反应并给以合理治疗和对中重度和治疗效果不佳的结核性脑膜炎适时的鞘内注药可改善患者的预后。患者的体质同预后有关。