| Objective: Tuberculous meningitis(TBM) is a non-suppurative inflammatory disease caused by Mtb(Mycobacterium tuberculosis) invade cerebrospinal membrane.It often has a an insidious onset with a nonspecific clinical presentation.The lack of a rapid and sensitive diagnostic test, which results in diagnostic and treatment delay,contributes to high mortality and morbidity.The sensitivity of traditional Zei M-Neelsen(TZN) ranges broadly in previous reports which hardly exceeded 20%.Modified Zei M-Neelsen(MZN) whose sensitivity and specificity is above 80% and makes Mtb in leukocyte visible has the following improvements over TZN:Adapting cytospin slides with Triton processing.MZN brings new hope to the diagnose of TBM.We analyzed the clinical datas of 170 patients with TBM cofirmed by MZN,aiming to investigate the features of MZN and cytology of cerebrospinal fluid(CSF) in TBM.Methods: We reviewed the clinical datas of 170 patients with tuberculous meningitis confirmed by MZN stain from December 2012 to December 2015 retrospectively and analyzed the feature of MZN and cytology of CSF.Results:1 Cytology of CSF1.1 Leukocyte counts of CSFCSF leukocyte counts of the patients in our study ranged from 0 to 5230×106/L,24.5% cases was less than 10×106/L,2.1% cases was more than 500×106/L.1.2 Changes of CSF cytology before receiving anti-tuberculosis(ATB) therapyCompareing CSF cytology in the 4-5th week and the 1th week after TBM onset found that neutrophil,monocyte percentage descended and lymphocyte percentage rised,however,leukocyte counts of CSF and the pecentage of activited monocyte had no remarkable changes.1.3 The first CSF cytology and prognosisClassified all cases to 4 teams according to the first CSF cytology,mixedly cellular cytology,lymphoid cytology,neutrophilic cytology,normal cytology.We compared prognosis of each team and found no difference among them.Classifing all cases into 2 teams according the percentage of lymphocyte and compareing prognosis of them,we found no differeces between one from another.The same happened in neutrophilic.1.4 The cytology type of CSF that was MZN positiveThe cytology type can be anyone when its MZN was positive,mainly presented as lymphoid cytology. Neutrophil occured in 64.1% MZN positive CSF with medium proportions of 22%(95%CI:27.4%~37.3%).2 MZN in CSF2.1 The first time AFB were evident inOf 75% patients with TBM confirmed by MZN staining, the first time acid-fast bacillus(AFB) be seen was in earlier stage(<1 month).It was 21.5(12.3,37.8)days after onset in patients who had revieved anti-TB therapy and 8.5(6.0,16.3)days in those not, P<0.0001.2.2 Relationship between MZN-potive time and cytology type of CSFThe first time when CSF was MZN positive may occur in any phase of disease,cytology type of CSF which was MZN positive can be anyone in every phase of disease,the time every cytology type appeared had no difference, all mainly in early stage.2.3 Anti-TB therapy and the time MZN turned negativeThe time MZN turned negative of 46 cases who had recived anti-TB therapy was 11(5.75,19.25)day,The time MZN turned negative of 4 cases who had not was 6(4.25,10.75)day.Two groups were compared and the difference had no statistical significance,P=0.23.Conclusions:1 CSF leukocyte counts of the patients in our study ranged from 77.5×106/L to 190.6×106/L,mainly presenting with lymphoid cytology with different proportions of neutrophil.2 Neutrophil,monocyte percentage descended and lymphocyte percentage rised in the end of the 1st month of TBM natural course,but the leukocyte counts of CSF and the pecentage of activited monocyte had no remarkable changes.3 The first CSF cytology had nothing to do with prognosis.4 The cytology type can be anyone when its MZN was positive fristly,mainly presented as lymphoid cytology which had nothing to do with the course of disease.5 The first time CSF MZN was positive mainly were in the 1th month,applying anti-TB therapy might affect the 1st time AFB were evident in. |
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