Review Article

The PCR-Based Diagnosis of Central Nervous System Tuberculosis: Up to Date

Table 3

The summary of basal clinical features in 24 patients with suspected TBM.

Patient No.Age/Sex *Clinical stageBasal CSF findings (before treatment) Single PCR
assay
Nested PCR
assay
WR-QNRT-PCR assay)
(copies/mL CSF)
Cranial
MRI findings
M.Tb outside CNSPeriod up to initial sample collectionATT responsE
Cells (/μL)Protein (mg/dL)Glucose
(mg/dL)
ADA (IU/L)AFB smearM.Tb culture

Confirmed cases

173/MIII2882991323.4+++28721ME, HC, CVD, IFMSp, GAAbout 3 weeksNoneffective
276/MIII1655694612.3+++10028ME, CVDSp2 daysEffective
328/MIII6054342516.3++22571ME, HC, CVD, IFMSpAbout 1 monthNoneffective
438/MII76637186.5++7161HC, IFMSp, GA1 dayEffective
553/FIII3443543810.3+++4547IFM1 dayEffective
672/FIII2473295718.4++6340HC, IFM7 daysNoneffective
734/MII6123201820.2+++1243Not availableEffective
842/MII4184563622.6+++10532ME, IFMSpAbout 2 weeksEffective

Highly probable cases

935/FII2083001316.3+7892ME, HC, CVD, IFM7 daysEffective
1065/FI10770487.8+19043 daysEffective
II52/MII18135548.6+5858ME, HC, CVD, IFMSp, GA1 dayEffective
1224/FI3025304.4+5436IFM1 dayEffective
1344/FIII607052N.D.+9600CVD1 dayEffective
1459/FII40359783.7+5112HCAbout 1 monthEffective
1544/MIII11787483.9+8400MESp, GAAbout 3 weeksNoneffective
1640/MIII8001886612+7050CVD1 dayEffective
1730/FIII720211509.7+5596IFM5 daysEffective
1820/FII4421644617.6Not detectedIFMGANot availableEffective
1963/MIII75844715.976MESpNot availableEffective
2063/FII342943012.7+188HCNot availableEffective
2153/MIII76818216.9+2592ME, IFMSp1 dayEffective
2251/MIII2271553412.7+636ME, CVD,
IFM
1 dayEffective
2366/MIII129120584.7+1600ME4 dayEffective
242/FII193119308.3+1444ME, HCNot availableEffective

(a) The clinical criteria suggestive for TBM are fever, headache, and neck stiffness of more than 1-week duration.
(b) supporting evidence for TBM include (1) compatible abnormal CSF findings that included increased white cell counts with lymphocytes predominating, c -hypoglycorrhachia, protein concentration >100 mg/dL, adenosine deaminase (ADA) ≧10 IU/L and negative results for routine bacterial and fungal cultures; (2) magnetic resonance imaging (MRI) findings suggesting tuberculous involvement of the CNS (basal exudates, hydrocephalus and intracranial focal mass, etc.); (3) presence of tuberculosis in the body outside of the CNS or a history of tuberculosis; (4) clinical response to antituberculosis therapy.
The suspected TBM cases were classified as “confirmed” cases (having the bacterial isolation for M.Tb such as CSF culture positive) or “highly probable” cases (meeting all the above clinical criteria and with all three supporting evidences positive).
*According to the clinical stages defined by the British Medical Research Council: stage 0: no definite neurologic symptoms, stage I: slight signs of meningeal irritation with slight clouding of consciousness, stage II: moderate signs of meningeal irritation with moderate disturbance of consciousness and neurologic defects, stage III: severe disturbance of consciousness and neurologic defects.
CSF: cerebrospinal fluid, PCR: polymerase chain reaction, TBM: tuberculous meningitis, M.Tb: Mycobacterium tuberculosis, ADA: adenosine deaminase, CNS: central nervous system, ME: meningeal enhancement, HC: hydrocephalus, CVD: cerebrovascular disorder, IFM: intracranial focal mass, Sp: sputum, GA: gastric aspirate, ATT: anti-tuberculosis treatment.