Critical Cerebrospinal Fluid Adenosine Deaminase Activity In Tubercular Meningitis

Background:Tuberculosis of the central nervous system accounts for ~5% of extrapulmonary cases in the United States. It is seen most often in young children but also develops in adults, especially those infected with HIV. If unrecognized, tuberculous meningitis is uniformly fatal. This disease responds to chemotherapy.Cerebrospinal fluid (CSF) evaluation is the single most important aspect of laboratory diagnosis of meningitis. Basic studies of CSF that should be performed in meningitis include measurement of pressure, cell count and differential count, estimation of glucose and protein levels, Gram's stain and culture.Objectives:To evaluate the diagnostic significance of CSF adenosine deaminase (ADA) activity in tuberculous meningitis.Material & Methods:70 Tubercular Meningitis patients who were admitted in Department of Medicine, Victoria hospital were included. The study was approved by the Ethical Committee of Bangalore Medical College and Research Institute, Bangalore. Patients were selected after fulfilling the following inclusion and exclusion criteria.Results:The mean age of the 70 patients studied was 39.82+16.48 years. The youngest patient was 18 years old and oldestpatient was 70 years.The mean value of ADA activity in tubercular meningitis was 18.07±8.03IU/L. Cut-off value of ADA in our study was 10 IU/. The result was statistically significant with a p value<0.001. Conclusion: The test for ADA in CSF is simple and can be carried out in a central laboratory with a rapid diagnosis, thus reducing unwarranted or harmful therapy for patients.Elevated CSF-ADA level helpsin differentiating tubercular from non-tubercular meningitis.

10 Cases of Paradoxical Expansion of Intracranial Terculomas During Chemotherapy / 결핵

BACKGROUND: Paradoxical intracranial tuberculoma is tuberculoma that developed or was enlarged during antituberculous therapy. The course of the disease or effective treatment are not well known. METHOD: Patients who developed intracranial tuberculoma or an enlarged tuberculoma during antituberculous therapy were investigated. Ten patients were enrolled. RESULTS: Paradoxical intracranial tuberculoma was detected 67.9 days after antituberculous therapy. The symptoms worsened over a period of 102.3 days. Improvement was noted after 165.4 days. Four patients recovered on the brain image and 4 recovered clinically. The CSF findings showed that the paradoxical tuberculomas had developed or were aggravated, the CSF findings was aggravated. CONCLUSION: Paradoxical intracranial tuberculoma can develop without specific symptoms. Paradoxical intracranial tuberculoma may not be a paradoxical response and may be a natural course of intracranial tuberculosis or a natural response to antituberculous therapy.