An unusual case of chronic meningitis

Diagnosis of tuberculous meningitis: Current scenario from a Tertiary Neurocare Centre in India

BACKGROUND

Tuberculous meningitis (TBM) is a condition that is caused by Mycobacterium tuberculosis complex and is difficult to diagnose due to the nonspecificity of the presentations. The study analyzed the different modes of diagnosis available in a developing country set up over a period of five years to understand the diagnostic values of the current conventional and automated methods of diagnosis of TBM among the patients suspected with chronic meningitis.

METHODS

A total of 10,281 cerebrospinal fluid samples (CSF) were collected from suspected chronic meningitis patients, of which 790 samples were from individuals who had clinically suspected TBM. The samples were subjected to CSF cytology and staining, culturing, immunological tests, molecular techniques, and methods for detection of drug resistance.

RESULTS

The TBM patients were predominantly male, with a mean age of 21-40 years. CSF pleocytosis and lymphocytic predominance were noted. Culture had 40.13% positivity among clinically suspected TBM patients. The multidrug-resistant M. tuberculosis (MDR-TB) constituted 3.14% of the total clinical isolates. With IS6110 PCR, a specificity of 92.86% and sensitivity of 100% are seen with an assay threshold of 30pg/ml. Line probe assay (LPA) using culture isolates had a sensitivity of 97.67% and a specificity of 100%. Direct CSF LPA showed a sensitivity of 96.15% and a specificity of 100%.

CONCLUSIONS

A combination of techniques that involved culture, cytology, and DNA amplification methods was found to be promising in specific, accurate, and rapid detection of M. tuberculosis in the CSF samples from patients.

Chronic meningococcemia in a 16-year-old boy: a case report

Herein, we present a case of meningococcal disease in a patient presenting with of a three-week history of fever, cutaneous vasculitis and joint pain, in whom chronic meningococcemia was retained as presumptive diagnosis, after the disease evolved towards meningitis. This unusual case illustrates the great heterogeneity in possible clinical presentations of Neisseria meningitidis infections and underlines that diagnosis should always be evocated when facing the triad of fever, vasculitic skin eruption and big joints arthralgia, in a person in otherwise good general condition.