The Analysis Of Clinical Features Of Tuberculous Meningitis In The Past Years

Tuberculous meningitis is the pathogen Mycobacterium tuberculosis(MTB) invade subarachnoid, causing meningitis, the parenchyma of the brain and spinal cord of the non specificity inflammation reaction of disease,It is one of the most common extra pulmonary tuberculosis. In recent years, due to gene mutation of Mycobacterium tuberculosis, AIDS patients is on the rise, immune function inhibition and steroid drugs widely used and, in some areas, anti-tuberculosis drugs don't use the standard, making clinical manifestations of atypical tuberculosis meningitis patients more and more, the clinician diagnosis of tuberculous meningitis brought great difficulties.Objective:To review of the general characteristics of the analysis of diagnosis of patients with tuberculous meningitis, clinical symptoms, signs and auxiliary examination results, summarize its clinical characteristics and early literature reported compared analysis differences help clinicians to diagnose of the tuberculous meningitis, especially understanding of the clinical manifestations of atypical tuberculous meningitis, so as to enhance the rate of clinical diagnosis, improve the prognosis of the patients.Methods:Collection of Xijing Hospital, Department of Neurology in June 2010 July2015 hospitalized 173 cases of tuberculosis meningitis in patients with clinical data using Excel 2013 in all cases, the general data, clinical characteristics, auxiliary examination data were collected and analyzed and with previous years tuberculous meningitis clinical characteristics of related literature were comparative study and application of statistical software SPASS 17.0 processing results.Results:The statistical results of the 173 cases diagnosed with tuberculous meningitis were as follows:(1)General characteristics: 113 cases of male, 60 female patients, mean age 34.9±12.8 years, age less than or equal to 20 patients accounted for 16.2%(28/173),21-30 years old patients accounted for 22.0%(38/173), 31-40 years old patients accounted for 14.5%(25/173), 41-50 years of age accounted for 19.7%(34/173), aged over 51 years old accounted for 26.6%(46/173). Review of the research and previous literature results:Previous tuberculous meningitis in patients under 30 years old accounted for more than80%, especially is children patients more, cases over the age of 50 less; gender female patients accounted for the majority, the male to female ratio is 1: 2.6.(2)Symptoms and signs: a clear history of tuberculosis or complicated with extracranial tuberculosis history accounted for 20.8%(36/173), the clinical symptoms of headache is 98.2%(169/173), fever is 72%(125/173), nausea is 40%(69/173), vomiting is30%(52/173), dizziness is 5%(9/173), consciousness disorders accounted for 4%(7/173),senior nerve dysfunction in 12.1%(21/173); cranial nerve damage clinical signs in 22.5%(39/173), the optic nerve and abducent nerve damage, accounted for 13.9(24/173), 12.1%(21/173); a stiff neck, Kernig syndrome and Brudzinski syndrome positive meningeal stimulation accounted for 28% of all patients(48/173), positive pyramidal sign 10.4%(18/173), a minority of patients with epilepsy(18/173). There are 10.4% extracranial tuberculosis history accounted for 8.1%(14/173), including 12 cases of pulmonary tuberculosis, 1 cases of abdominal tuberculosis, 1 cases of tuberculous myelitis. The retrospective analysis and early literature comparison, the previous tuberculous meningitis with fever, fatigue, general malaise and so on tuberculosis poisoning onset of symptoms(90%) and disturbance of consciousness(53%) accounted for most; signs to stiff neck,Kernig syndrome and Brudzinski syndrome meningeal sign stimulus syndrome, accounted for all of the patients larger proportion(80%); injury of cranial nerve, oculomotor nerve damage(23.1%), facial nerve paralysis accounted for 21.5%, auditory nerve paralyse is accounted for 10%.(3)Auxiliary examination: the study group patients were treated in our hospital modified acid fast staining found Bacillus confirmed in this study, 173 cases of tuberculous meningitis in cerebrospinal fluid of patients with high white blood cell count was 85%(147/173); found that white blood cells each distribution ratio of numerical statistics, the normal range of tuberculous meningitis cerebrospinal fluid leukocyte count(0-10/mm3) accounted for 15%, 100/mm3 following a total of 46%(80/173); cerebrospinal fluid white blood cell found in neutrophils was 82%(143/173), content of less than 10%accounted for 47.4%, the proportion of accounts for 7%-16%, from 10% to 100% cases of lymphocyte ratio increased gradually, and mononuclear cells the proportion is gradually decreased. The statistical results showed that the patients of cerebrospinal fluid cytology and early literature contrast: the previously reported results, normal white blood cell count less, increased up to 90%, and the count <100 /mm3(41%), is the proportion of research With less visible. Before the cerebrospinal fluid of patients with tuberculous meningitis were higher number of white blood cells. Typical tuberculous meningitis cerebrospinal fluid cytology dynamic acute stage mainly neutrophils, as the disease progresses, subacute stage is mixed cell reaction, neutrophils decreased gradually with lymphocytes. The cases of cerebrospinal fluid protein increased 91.2%(156/173), and the median increase for1.38g/L; reduce the glucose content of cerebrospinal fluid(<2.2mmol/L) accounted for31.2%(54/173), increased the median of 1.4 mmol/L(<110mmol /L); chloride decreased about 20%(34/173), increased the median 104.25mmol/L. Previous reports found that CSF glucose decreased(<20mg%), chloride(reducing 500-600mg%) the ratio is low,respectively 19% and 32%, cerebrospinal fluid protein increased accounted for 97%,slightly higher than the data in this study. Cerebrospinal fluid immunoglobulin increased generally, Ig G, Ig A, Ig M, Alb increased respectively, accounted for 81.3%, 79.4%, 90.8%,53.2%; cerebrospinal fluid cell staining detection antigen ESAT-6 and PPD, positive raterespectively 56.1%(55/98), 22.0%(9/41), blood T-SPOT and cerebrospinal fluid(CSF)X-pert detection positive rate respectively is 44.1%(41/93), 38.20% 21/55. Positive rate of were lower. Cranial CT/MRI images with typical meningoencephalitis changes accounted for 21.1%(35/166), hydrocephalus 7.2%(12/166) brain vascular disease 6.7%(11/166), multiple demyelinating changes 8.4%(14); approximately 32.5%(54/166) no obvious abnormalities.Conclusion:(1)The cases statistics found that tuberculous meningitis in age and sex and in the past have obvious changes. The current node brain age of onset has two peak, a is over 51 years old, another is 21-30 year-old youth; total incidence rate in male was more than female, only in 20 years old of the following groups of female incidence rate was slightly higher. And the earlier research suggesting the onset age is mainly under 30 years old youth and children(80%) and female incidence rate high situation is significantly different.(2)Symptoms and signs: the clinical manifestation of the cases with the past data compared overall severity than before light, serious and typical tuberculous meningitis symptoms and signs, such as systemic tuberculosis symptoms of poisoning, high intracranial pressure and disturbance of consciousness, meningeal irritation sign ratio compared with the previous low. The proportion of cranial nerve damage also reduced more than half, major damage to the optic nerve, abducens nerve, unlike the previous major damage to the oculomotor nerve and facial nerve, the reason is not clear. Mental obstacle occurrence rate of both is basically the same. Secondary epileptogenesis rate of about 10%.(3)The difference between the cases of cerebrospinal fluid cytology, and the traditional thought are: the appearance of multiple clear cerebrospinal fluid, increased intracranial pressure accounted for only 34.7%. white blood cell count of 100 /mm3 below the total 46% patients, and the traditional was found in the 100-500 /mm3 with cerebral white blood cell number and the number of patients with cerebrospinal fluid; 15% white blood cells in the normal range, usually clinicians might not consider the diagnosis oftbm,it should improve our vigilance. Many different types of white blood cells, neutrophils were found in 82% of patients, but with 10% of the proportion of neutrophils following nearly half(47.4%), so this group of patients with CSF is low the proportion of cases. A higher proportion of abnormal CSF protein and immunoglobulin, and abnormal glucose and chloride is relatively low, suggesting that the former has higher sensitivity in the diagnosis of TBM.(4)Other laboratories etiological examination, such as cerebrospinal fluid cell staining detection antigen ESAT-6 and PPD, positive blood T-SPOT and cerebrospinal fluid(CSF)X-pert check rate are compared with low and expensive, complex procedures, only as a less auxiliary examination of the patients.(5)The abnormal rate of brain imaging examination showed about 30%, reflecting its importance in the diagnosis of node in the brain, and can locate the damage range, is an important tool for diagnosis of tuberculous meningitis.In conclusion, due to changes in various factors, the tuberculous meningitis incidence,clinical manifestations, cerebrospinal fluid changes, imaging findings of more and more not typical, clinicians easily lead to or misdiagnosis, so clinicians should raise vigilance,for nodes in the brain of patients with various atypical manifestation to raise awareness, so as to improve the correct diagnostic rate of the node of the brain.