ABSTRACT
Objective To investigate the dynamic changes of cerebrospinal fluid (CSF) cytology in the course of tuberculous meningitis (TBM) and its diagnostic value.Methods 37 children with TBM who were treated in the department during January 2008 to December 2016 were selected as the observation group.Another 40 children with non-TBM (including viral encephalitis and suppurative encephalitis) were selected as the control group at the same time.The CSF samples were collected for routine,biochemical and CSF cytological examinations.The detection of mycobacterium tuberculosis antigen pure protein derivative (PPD) positive cell rate (monocyte) was performed,and the value of CSF cytology in the diagnosis of TBM was summarized.Results (1) The lumbar puncture pressure,white blood cell count,lymphocyte count and protein quantification in the observation group were higher than those in subgroups of the control group,while the glucose and chloride levels were lower than those in the subgroups (P ＜ 0.05).(2) The cytological examination of CSF in the observation group mainly was mixed cell reaction,accounting for 83.78％,followed by lymphocyte reaction (10.81％).Viral meningitis mainly manifested as lymphocyte reaction,accounting for 82.14％,while suppurative meningitis mainly manifested as polymorphonnclear response,accounting for 75.00％.(3) The positive rate of PPD antigen in the observation group was 81.08％,which was significantly higher than that in children with viral meningitis,suppurative meningitis (P ＜ 0.05).(4) The accuracy rate of protein level ＞0.45 g/L in the diagnosis of TBM was 89.19％,and the accuracy rate of CSF cytological mixed cell response was 83.78％.(5) The white blood cell count,the proportion of monocytes and the proportion of neutrophils were the highest in children with tuberculous meningitis less than 2 weeks,compared with those in children with 3-4 weeks and ＞4 weeks (P ＜0.05).The above-mentioned cytological indexes were decreased while the proportion of lymphocytes was increased in children with TBM whose course of disease was 3-4 weeks.The white cell count,proportions of monocytes,lymphocytes and proportion of neutrophils in children whose course of disease was longer than 4 weeks were lower than those in children whose course of disease was 3-4 weeks (P ＜ 0.05).Conclusions The white blood cell count,proportion of monocyte and proportion of neutrophils were relatively higher in the first 2 weeks of TBM,and maintained for 2 weeks.2 weeks later,levels of above-mentioned cells decreased except for lymphocytes while the proportion of lymphocytes increased continuously and then decreased gradually 4 weeks later.The diagnostic accuracy rate of CSF cytological mixed reaction to TBM was relatively higher,and the consistency with tuberculosis antigen PPD examination was high,which could be used as a choice for early diagnosis of TBM.
ABSTRACT
Objective To investigate the clinical characteristics of childhood purulent meningitis (PM)and the risk factors for its adverse outcome.Methods One hundred and nine children with PM were retrospective ana-lyzed,who were admitted to pediatric department in Xijing Hospital of the Fourth Military Medical University from Ja-nuary 2008 to July 201 6.They were divided into 5 age groups,the clinical features were compared among the different age groups.According to Glasgow prognostic score,all cases were then divided into 2 groups,the favorable outcome group and the adverse outcome group.All factors including normal information,disease history,clinical manifestations and laboratory examinations were compared between 2 groups.Results There were 72.5% (79 /1 09 cases)of the pa-tients younger than 3 years old.PMwas prone to spring and winter,and most children with PMhad preceding infection. The major clinical manifestations of PM were fever,convulsions and intracranial hypertension.The clinical manifesta-tions of PMwere different in different age groups,and convulsions were more commonly seen in less than 3 years old children,while headache,vomiting and meningeal stimulation had higher proportion in more than 3 years old children. The single factor analysis showed that there were repeated convulsions after admission (≥3 times),the cerebrospinal fluid (CSF)glucose(≤1 .5 mmol/L),CSF protein(≥1 g/L),CSF /blood glucose ratio and complications were signifi-cantly different between 2 groups(all P 500 ×1 06 /L,blood and CSF cultivate positive rate, co -infection,brain CT/MRI abnormality,electroencephalogram abnormality,treatment and duration of seizure more than 5 minutes were not significantly different(all P >0.05).Multivariate analysis showed that there were repeated convulsions after admission (≥3 times)(OR =27.84,P =0.048),CSF protein(≥1 g/L)(OR =28.44,P =0.027) and low CSF /blood glucose ratio (OR =22.1 5,P =0.041 )were independent risk factors for poor prognosis of PM. Conclusion PMhappens mostly in infantile period,with different clinical manifestations at different ages.The inde-pendent risk factors for poor prognosis were repeated convulsions after admission (≥3 times),CSF protein(≥1 g/L) and low CSF /blood glucose ratio.It indicates that if the high risk factors could be identified early,and then intervened immediately and followed up timely,it will be beneficial to improve the long -term prognosis.