2416. Clinical Signs and Parameters for Distinguishing Tuberculous Meningitis from Viral Meningitis
Session: Poster Abstract Session: Tuberculosis: Epidemiology and Management
Saturday, October 7, 2017
Room: Poster Hall CD
Posters
  • IDweek 2017 TB meningitis 9.22.2017 poster PDF version.pdf (798.3 kB)
  • Background:

    The diagnosis of tuberculous meningitis (TBM) is challenging and is often difficult to differentiate from viral meningitis, especially in the early phase of TBM because of lack of accurate diagnostic methods. The aim of this study is to identify independent predictive factors for diagnosis of TBM differentiating from viral meningitis.

    Methods:

    We conducted a retrospective cohort study at St. Luke’s Intl Hosp (530 beds, acute care hosp in Tokyo). We reviewed the medical records of pts aged >15 years with TBM and viral meningitis from Jan 2002 to Jul 2014. TBM was defined according to a uniform case definition and clinical judgment on efficacy with antituberculous therapy. Demographic, clinical, microbiological, cerebrospinal fluid (CSF) and imaging data were analyzed to identify independent factors associated with TBM comparing with viral meningitis using univariate and multivariate analysis.

    Results:

    We identified 21 pts with TBM and 119 pts with viral meningitis. Univariate analysis of the factors associated with TBM revealed a significant association with 6 variables; (TBM vs Viral) : age (mean 53.0 vs 36.8, P<0.01), neurogenic bladder (47.6% vs 2.6%, P<0.01), cranial nerve palsy (63.2% vs 5.1%, P<0.01), extrapyramidal symptoms (45.0% vs 6.7%, P<0.01), altered mental status (57.1% vs 8.6%, P<0.01) and CSF-protein level > 150mg/dl (66.7% vs 15.2%, P<0.01), and CSF-ADA:U/L (mean 10.30 vs 4.2, P=0.021) Multivariate analysis revealed that neurogenic bladder (odds ratio [OR] =16.32, 95% confidence interval [CI] : 2.01-132, P=0.009), cranial nerve palsy (OR= 7.26, 95% CI: 1.54-34.2, P=0.012) , and CSF-protein level>150mg/dl (OR=5.43, 95% CI: 1.07-27.7, P=0.042) were highly and independently associated with TBM.

    Conclusion:

    Neurogenic bladder and cranial nerve palsy, and high CSF-protein level > 150 mg/dl might be important signs and parameter for making a diagnosis of TBM differentiating from viral meningitis.

    Table 1: Multivariate analysis of factors associated with TBM

    Variables

    Odds ratio

    95% Confidence interval

    p-value

    Neurogenic bladder

    16.3

    2.01-132

    0.009

    Cranial nerve palsy

    7.26

    1.54-34.2

    0.012

    CSF-protein>150mg/dl

    5.43

    1.07-27.7

    0.042

    Extrapyramidal symptoms

    2.04

    0.35-12.1

    0.431

    CSF-ADA>7 U/L

    1.00

    0.18-5.42

    0.998

    Aki Sakurai, MD, 2222, Maroneal St., 2222, Maroneal st., Houston, TX, Hideaki Sofue, MD, Internal Medicine, St. Luke's International Hospital, Tokyo, Japan and Keiichi Furukawa, MD, Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan

    Disclosures:

    A. Sakurai, None

    H. Sofue, None

    K. Furukawa, None

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