1189. Tuberculous Meningitis-mimicking Varicella-Zoster Meningitis
Session: Poster Abstract Session: Clinical Infectious Diseases: CNS Infection
Friday, October 28, 2016
Room: Poster Hall
Background: The severe manifestation of VZV meningitis is occasionally confused with tuberculous meningitis (TBM), especially in TB endemic areas. However, there are limited data on TBM-mimicking VZV meningitis. We thus investigated the clinical manifestations of VZV meningitis compared with those of TBM in an intermediate TB-burden country.

Methods: All adult patients who were diagnosed with VZV meningitis or TBM were enrolled at a tertiary hospital, Seoul, South Korea, during an 8-year period.

Results: Seventy-nine patients with VZV meningitis and 24 patients with TBM were enrolled in this study. Of 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). The clinical manifestations between VZV meningitis (group 1 vs. group 2) and TBM (group 3) were shown in Table 1.

Conclusion: About one fifth of VZV meningitis was presented as severe manifestations mimicking mild forms of TBM. The CSF/serum glucose ratio might be useful to differentiate VZV meningitis from TBM until the definite diagnostic tests are available. Physicians should keep in mind that the differential diagnosis between severe VZV meningitis and a mild form of TBM is needed.
Table 1. Comparison of clinical characteristics and laboratory findings between VZV meningitis with or without empirical antituberculous therapy and TBM

VZV meningitis without

anti-TB therapy (group 1)

(n=63)

VZV meningitis with

anti-TB therapy (group 2)

(n=16)

TBM (group 3)

(n=24)

p-value
Clinical manifestations
 Altered mental status 6 (10) 6 (38) 17 (71) <0.001
 Seizure 2 (3) 0 5 (21) 0.009
Clinical diagnosis <0.001
 Meningitis 56 (89) 8 (50) 8 (33)
 Encephalitis 7 (11) 8 (50) 16 (67)
Course of illness
 ICU hospitalization 4 (6) 4 (25) 10 (42) <0.001
 Assisted ventilation 1 (2) 2 (13) 6 (25) <0.001
Outcome
 Neurologic sequelae at discharge 11 (18) 6 (38) 10 (46) 0.007
CSF findings
 WBC, cell/mm3 230 (65 - 500) 201 (93 - 419) 213 (123 - 383) 0.55
 Lymphocyte, % 79 (58 - 89) 83 (54 - 91) 60 (27 - 74) 0.03
 CSF/serum glucose ratio 0.50 (0.45 - 0.53) 0.47 (0.36 - 0.51) 0.21 (0.15 - 0.33) <0.001
 Protein, mg/dL 85 (58 - 127) 128 (100 - 210) 202 (129 - 322) <0.001
 ADA, U/L 3.4 (1.7 - 6.0) 7.7 (4.8 - 13.0) 13.3 (9.2 - 20.8) <0.001

 

NOTE. Data are presented as the number of patietns (%) or medians (IQR).

Sun In Hong, MD1,2, Young Rock Jang, MD3, Min-Chul Kim, MD3, Taeeun Kim, MD4, Se Yoon Park, MD4, Yong Pil Chong, MD5, Sang-Oh Lee, MD5, Sang-Ho Choi, MD5, Yang Soo Kim, MD5, Jun Hee Woo, MD5, Sang-Ahm Lee, MD, PhD6 and Sung-Han Kim, MD5, (1)Department of Infectious Diseases, Gyeongsang National University Changwon Hospital, Changwon, Korea, The Republic of, (2)Department of Infectious Diseases, Gyeongsang National University Changwon Hospital, Changwon, South Korea, (3)Asan Medical Center, Seoul, Korea, The Republic of, (4)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, (5)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, The Republic of, (6)Department of Neurology, Asan Medical Center, Seoul, Korea, The Republic of

Disclosures:

S. I. Hong, None

Y. R. Jang, None

M. C. Kim, None

T. Kim, None

S. Y. Park, None

Y. P. Chong, None

S. O. Lee, None

S. H. Choi, None

Y. S. Kim, None

J. H. Woo, None

S. A. Lee, None

S. H. Kim, None

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