Objective To comprehensively observe, recognize, learn and understand the clinical features of tuberculous meningitis (TBM). Methods We retrospectively analyzed the general data, clinical manifestations, clinical examinations and treatment prognosis of 152 patients with TBM who were hospitalized in the Second Affiliated Hospital of Zunyi Medical College between January 2016 and February 2017. Results The mean age of the 152 patients with TBM was (43.9±20.4) years old, the ratio of male to female was 1.45:1, and the average length of hospital stay was (20.0±18.9) days. The clinical manifestations were mainly headache [95.4% (145/152)], nausea and vomiting [42.8% (65/152)], and fever [61.8% (94/152)]. The main co-morbidities were secondary pulmonary tuberculosis [52.0% (79/152)], hematogenous disseminated tuberculosis [37.5% (57/152)], and tuberculous pleurisy [30.9% (47/152)]. The positive rate of γ-interferon release test was 90.8% (129/142), and the brain pressure of lumbar puncture was elevated. The typical biochemical changes of cerebrospinal fluid were " low glucose, low chlorine, and high protein”. The positive rate of tuberculosis smear was extremely low, and the positive rate of GeneXpert MTB/RIF in cerebrospinal fluid was 21.9% (7/32). The TBM patiens were prone to combine with hypoproteinemia, the proportion reached 29.6% (45/152), and the proportion of hyponatremia reached 45.3% (69/152). Treated with early diagnosis and treatment, 92.1% (140/152) improved and discharged. Conclusions TBM patients are mainly young and middle-aged with various clinical manifestations and less respiratory symptoms; and are easy to be combined with pulmonary tuberculosis and other extrapulmonary tuberculosis. γ-interferon release test and cerebrospinal fluid GeneXpert MTB/RIF can be used for the auxiliary diagnosis of tuberculosis. Early detection, early diagnosis and treatment, rational and regular chemotherapy, strengthening symptomatic supportive treatment, and improving the precise diagnosis and treatment of TBM, can improve its clinical prognosis.
Objective To explore the predictive factors for long-term adverse prognosis in patients with tuberculosis meningitis. Methods We retrospectively analyzed the clinical data (general clinical data, laboratory test results, and imaging findings) of hospitalized cases of tuberculosis meningitis admitted to West China Hospital of Sichuan University from 00:00:00 on August 1st, 2011 to 23:59:59 on July 31st, 2012. We collected data of prognosis results after 6 years of illness by telephone follow-up, and quantified outcome measures by modified Rankin Scale (mRS) score (0–6 points). According to the mRS score, the cases obtaining 0 points≤mRS<3 points were divided into the good prognosis group and the cases obtaining 3≤mRS≤6 points were divided into the poor prognosis group, logistic regression analysis was executed to find the independent risk factors affecting long-term poor prognosis. Results A total of 119 cases were included, including 63 males and 56 females; the average age was (35±17) years. Among them, 53 patients had poor prognosis and 66 patients had good prognosis. After univariate analysis, the age (t=–3.812, P<0.001), systolic blood pressure at admission (t=–2.009, P=0.049), Glasgow Coma Scale score (t=3.987, P<0.001), Medical Research Council (MRC) staging system (Z=–4.854, P<0.001), headache (χ2=4.101, P=0.043), alter consciousness (χ2=10.621, P=0.001), cognitive dysfunction (χ2=4.075, P=0.044), cranial nerve palsy (χ2=5.853, P=0.016), peripheral nerve dysfunction (χ2=14.925, P<0.001), meningeal irritation (χ2=7.174, P=0.007), serum potassium (t=3.080, P=0.003), cerebrospinal fluid protein content (Z=–2.568, P=0.010), cerebrospinal fluid chlorine (t=2.543, P=0.012), hydrocephalus (χ2=11.766, P=0.001), and cerebral infarction (χ2=6.539, P=0.012) were associated with long-term poor prognosis of tuberculosis meningitis. Multivariate analysis showed that age [odds ratio (OR)=1.061, 95% confidence interval (CI) (1.027, 1.096), P<0.001], peripheral nerve dysfunction [OR=3.537, 95%CI (1.070, 11.697), P=0.038], MRC Stage Ⅱ[OR=9.317, 95%CI (1.692, 51.303), P=0.010], MRC Stage Ⅲ [OR=43.953, 95%CI (3.996, 483.398), P=0.002] were the independent risk factors for long-term poor prognosis of tuberculosis meningitis. Hydrocephalus [OR=2.826, 95%CI (0.999, 8.200), P=0.050] might be an independent risk factor for long-term poor prognosis of tuberculosis meningitis. Conclusions Age, MRC staging system (Stage Ⅱ, Stage Ⅲ) and peripheral neurological dysfunction are chronic poor-prognostic independent risk factors for tuberculosis meningitis. Hydrocephalus may be associated with long-term adverse prognosis of tuberculosis meningitis
ObjectiveTo analyze the curative effect and prognosis of drug resistant tuberculosis meningitis (TBM). MethodsRetrospective analysis was carried out on the clinical data of thirty-two cases of drug resistant tuberculous meningitis patients hospitalized from January 2010 to December 2015. And the prognosis of the patients was evaluated by meliorated Rankin Scale (mRS). ResultsThirty-one cases (96.9%) were improved in 32 patients with drug resistant TBM, and 1 case (3.1%) was ineffective. After treatment, one patient had hormone-related glaucoma and osteoporosis, and one patient had drug Cushing syndrome. Twenty-seven patients (84.4%) had an mRS score equal to or less than 2 points. ConclusionDrug resistant TBM is difficult to diagnose in the early stage, and the curative effect is satisfying with active anti-tuberculosis treatment.
Objectives We tended to evaluate the effectiveness of prophylactic antibiotics for preventing meningitis in patients with BSF. Method We searched the Cochrane Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to September 2005), EMBASE (1974 to June 2005), and LILACS (1982 to September 2005). We also performed an electronic search of meeting proceedings from the American Association of Neurological Surgeons (1997 to September 2005) and handsearched the abstracts of meeting proceedings of the European Association of Neurosurgical Societies (1995, 1999 and 2003). Randomized controlled trials (RCTs) comparing any antibiotic versus placebo or no intervention were identified. We also identified non-RCTs to perform a separate meta-analysis to compare results. At least two authors independently appraised the quality and extracted the data of each trial. Meta-analysis was conducted using RevMan 4.2 software. Results Five RCTs and 17 non-RCTs comparing different types of antibiotic prophylaxis with placebo or no intervention in patients with BSF were identified. Most trials presented insufficient methodological detail. All studies included meningitis in their primary outcome. Overall, we evaluated 208 participants from the four RCTs that were considered suitable for inclusion in the meta-analysis. There were no significant differences between antibiotic prophylaxis groups and control groups in terms of reduction of the frequency of meningitis, all-cause mortality, meningitis-related mortality, and need for surgical correction in patients with CSF leakage. We performed a subgroup analysis to evaluate the primary outcome in patients with and without CSF leakage. We also completed a meta-analysis of all the identified controlled non-RCTs (enrolling a total of 2 168 patients), producing results consistent with the randomised data. Conclusions Currently available evidence from RCTs does not support prophylactic antibiotic use in patients with BSF, whether there is evidence of CSF leakage or not. Until more research is completed, the effectiveness of antibiotics in patients with BSF cannot be determined because studies published to date are flawed by biases. Large, appropriately designed RCTs are needed.
Objective To investigate the clinical features of tuberculous meningoencephalitis.Methods The clinical characteristics and laboratory results of 126 cases who were diagnosed as tuberculous meningoencephalitis fromJanuary 2000 to April 2009 were analyzed retrospectively. Results The clinical manifestations of tuberculous meningoencephalitis included fever, headache, vomitting, hemiparalysis,paraplegia, mental anomaly, hypopsia, deafness, diplopia, muscular spasms, coma, and incomplete oculomotor palsy, etc. Vomitting which was characteristic symptom of tuberculous meningoencephalitis was found in 25 cases( 19. 8% ) . The diagnosis was confirmed more than eightweeks after the onset of the disease in 31 cases ( 24. 6% ) . The inhospital mortality rate of tuberculous meningoencephalitis was 14. 3% ( 18 /126) . The inhospital mortality rate of re-treatment patients was 42. 9% ( 6 /14) . In 41 patients with poor prognosis ( death or therapy failure) , 68. 3% ( 28/41) cases were complicated with military tuberculosis, which was higher than the overall occurrence of 41. 3% ( 52/126) . Conclusions Strict diagnostic criteria and atypicalsymptoms lead to delayed diagnosis, delayed treatment, and high mortality in patients with tuberculous meningoencephalitis, particularly in patients with military tuberculosis and re-treatment patients. There is still no effective treatment which have a significant impact on the prognosis.
ObjectiveTo systematically review the quality of evidence-based guidelines (EBGs) on medication therapy for neonatal bacterial meningitis, and compare differences and similarities of the drugs recommended, in order to provide references for clinical application. MethodsDatabases such as the TRIP, PubMed, CNKI, VIP, WanFang, CBM, National Guideline Clearinghouse and Guidelines International Network were searched to collect evidence-based guidelines on medication therapy for neonatal bacterial meningitis. Methodological quality of included studies was assessed according to the AGREE Ⅱ instrument, and the differences and similarities among recommendations were compared. ResultsA total of 4 EBGs were included. Among them, one guideline was developed by the America and three guidelines were by the UK. Only one guideline was developed specially for neonates, while the rest were for neonates and children of different ages. According to the AGREE Ⅱ instrument, "scope and purpose", "stakeholder involvement", "rigor of development", "clarity and presentation", "applicability" and "editorial independence" were scored more than 60%. The recommendations of different guidelines were basically the same, only with conflicts in some areas. ConclusionAlthough most guidelines concerning neonatal bacterial meningitis are of high quality, grading levels of evidence and strength of recommendation should be unified.
ObjectiveTo investigate the epidemiological and economic burden of acute meningitis and encephalitis syndrome (AMES) in Jinan, so as to provide references for prevention and control of AMES. MethodsThe monitoring data of the AMES Special Reporting System of Jinan City from 2007 to 2014 was collected and the epidemiological characteristics of AMES were analyzed. A questionnaire survey was performed in AMES patients reported in 2013 to collect the basic information, prognosis, medical and non-medical expenses etc. of patients. The DALYs and economic burden of AMES were estimated by using SPSS 13.0 software. ResultsThe average incidence rate of AMES in Jinan was 8.49/100 000 through 2007 to 2014 and the mortality was 4.96‰. The total DALYs were 36 659.51 and the average DALY was 8.27.77.86% were aged less than 14 years old. The average direct economic burden of each case was 19.5 thousand RMB and the average indirect economic burden caused by DALYs was 69.1 thousand RMB. ConclusionThere's heavy burden from AMES, and measures should be made to reduce the incidence and economic burden.