Clinical Signs and Parameters for Distinguishing Tuberculous Meningitis from Viral Meningitis. (4th October 2017) - Sakurai, Aki
Abstract: 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 patients aged >15 years with TBM and viral meningitis from January 2002 to July 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 patients with TBM and 119 patients 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 >150 mg/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. Disclosures: All authors: No reported disclosures.