997. Clinically Latent Disease of Tuberculous Meningitis -Experience in Japan-
Session: Poster Abstract Session: Clinical Studies of Tuberculosis
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Tuberculous meningitis (TBM) needs prompt diagnosis and adequate treatment because of its rapidly progressive and uniformly fatal course. It is well known that adjunctive treatment with corticosteroids may reduce the risk of disability or death among adults with TBM. Meanwhile, there is “latent tuberculous meningitis”, that is only inflammatory changes of cerebrospinal fluid (CSF) without central nervous system (CNS) symptoms in patients with disseminated tuberculosis. It is difficult to diagnose latent TBM due to no CNS symptoms. Diagnosis of it, however, might lead to better prognosis due to adequate antituberculosis treatment with corticosteroids.

Methods: A total of 18 adult patients, who were diagnosed as disseminated tuberculosis and done by CSF analysis from May 2008 to April 2011, were retrospectively reviewed to investigate the clinical features of latent TBM. TBM was diagnosed by inflammatory changes of CSF (cells>10 /μl or protein content > 50mg/dl). Among 18 patients, 4 ones were diagnosed as TBM, including 2 CNS symptomatic TBM cases and 2 latent TBM ones. All 4 patients with TBM were treated with both multiagent antituberculosis chemotherapy and  corticosteroids. Patients were divided into “symptomatic TBM” and “latent TBM”. Background, clinical features, CSF test results were compared between these 2 groups.

Results: There was no significant differences in clinical background, including age, severity of disseminated disease and test results in CSF, between symptomatic TBM group and latent TBM group (Age: 56±8 years and 62±7 years, CSF results: leukocyte count 36±13 /μl and 52±9 /μl, protein levels 70±8 mg/dl and 108±0 mg/dl, glucose levels 49.5±3.5 mg/dl and 49±7.0 mg/dl, respectively in symptomatic TBM group and latent TBM group). The latter, however, tends to be older and to show more cells and protein levels in CSF. One of 2 patients with symptomatic TBM left CNS sequelae, but all 2 patients with latent TBM recovered without seruelae.

Conclusion: We reported disseminated tuberculous disease with clinically latent meningitis. It is suggested that we might apply aggressive spinal tap examination to CNS asymptomatic patients with disseminated TB.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Toru Tanaka, MD1, Yoshiya Tsunoda, MD2, Hiroyuki Takoi, MD2, Shin-yuan Lin, MD2, Yohei Yatagai, MD2, Akimasa Sekine, MD2, Ataru Moriya, Medical technologist3, Yasuhiro Umetsu, MD4, Kenji Hayashihara, MD2 and Takefumi Saito, MD, PhD2, (1)Department of Internal Medicine, National Hospital Organization Ibarakihigasi Hospital, Ibaraki, Japan, (2)Departmen of Internal Medicine, National Hospital Organization Ibarakihigasi Hospital, Ibaraki, Japan, (3)Department of Clinical Laboratory, National Hospital Organization Ibarakihigasi Hospital, Ibaraki, Japan, (4)Clinical Research, National Hospital Organization Ibarakihigasi Hospital, Ibaraki, Japan

Disclosures:

T. Tanaka, None

Y. Tsunoda, None

H. Takoi, None

S. Y. Lin, None

Y. Yatagai, None

A. Sekine, None

A. Moriya, None

Y. Umetsu, None

K. Hayashihara, None

T. Saito, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.