Clinical and Cerebrospinal Fluid Abnormalities as Diagnostic Tools of Tuberculous Meningitis
Abstract: Tuberculous
meningitis (TBM) is the most severe form of extrapulmonary tuberculous (TB)
disease and remains difficult to diagnose. The aim of the study was to
determine the diagnostic value of clinical and laboratory findings of
cerebrospinal fluid (CSF) examinations for diagnosing TBM using bacterial
culture result as the gold standard.
Methods: A prospective cross sectional study was carried out to 121
medical records of hospitalized TBM patients in neurological ward at Dr. Hasan
Sadikin General Hospital Bandung, from 1 January 2009–31 May 2013. The
inclusion criteria were medical records consisted of clinical manisfestations
and laboratory findings. The clinical manisfestations were headache and nuchal
rigidity, whereas the laboratory findings were CSF chemical analysis (protein,
glucose, and cells) and CSF microbiological culture. Validity such as
sensitivity, specificity, positive predictive value (PPV), negative predictive
value (NPV) for clinical and laboratory findings were calculated, using
bacterial culture result as the gold standard.
Results: The most clinical findings of TBM was nuchal rigidity and it had
the highest sensitivity value, but the lowest spesificity value. Decreased of
CSF glucose had the highest sensitivity value compared to other laboratory
findings, but the value was low.
Conclusions: The clinical manisfestations and the laboratory findings are
not sensitive and specific enough for diagnosing TBM.
Keywords: Cerebrospinal fluid,
clinical manisfestations, diagnostic tools, laboratory findings, tuberculous
meningitis
Author: Fiona Lestari, Sofiati
Dian, Ida Parwati
Journal Code: jpkedokterangg160108
