final program.qxd - Parallels Plesk Panel

PP 3.11
Clinicopathological comparison of Tuberculous and Cryptococcal meningitis
presenting to a tertiary care hospital in Pakistan
Rahmat Ali, Afrasyab Khan, Bushra Jamil, Arshad Iqbal, Saad Ali.
1) Dr. Rahmat Ali The Aga Khan University, Medical College, Department of B&BS Karachi
Pakistan 2) Afrasyab Khan. Medical Student Class of 2007 The Aga Khan University,
Medical College, Male Hostel Room No. 211 Karachi Pakistan 3) Dr. Bushra Jamil.
Assistant Professor Department of Pathology and Microbiology Aga Khan University
Stadium Road, P.O. BOX 3500 Karachi 74800, Pakistan 4) Arshad Iqbal. Medical Student
Class of 2009 The Aga Khan University, Medical College, Male Hostel Room No. 134
Karachi Pakistan 5)Dr. Saad Ali Medical Student Class of 2009 The Aga Khan University,
Medical College, Male Hostel Karachi Pakistan
Objectives
Tuberculous meningitis (TBM) and cryptococcal meningitis (CCM) are two common types
of chronic meningitis. It is very difficult to differentiate TBM (seen in immunocompetent
individuals) from cryptococcal meningitis. In the current study we tried to address
Clinicopathological comparison of Tuberculous and Cryptococcal meningitis presenting to
a tertiary care hospital in Pakistan.
Methods
The data were collected, retrospectively from the medical records of the patients who
presented to AKUH with tuberculous (n=16) and cryptococcal (n=11) meningitis during a
10 year period from 1995 to 2005. The signs and symptoms, laboratory findings and other
variables were compared. None of the patients with TBM were HIV positive while four
patients with CCM had AIDS.
Results
The common initial signs and symptoms in patients with TBM were fever (81.3%), altered
mental status (68.8%) and headache (62.5%) and in patients with CCM were fever
(90.9%), headache (72.7%) and cough (54.5%). The mean CSF values for the patient with
TBM and CCM were: WBCs count: 228/mm 3 and 529.54 mm 3 , RBCs: 2010.75/mm 3 and
178.54/ mm 3 , glucose: 52.33 mg/dL and 32.63mg/dL, protein: 289.48mg/dl and
432.18mg/dL respectively. Three patients with TBM were determined to be in clinical stage
1, 11 in stage 2 and 2 in stage 3 of the MRC criteria. The mean CSF glucose level
decreased according to the stage in TBM. Four patients with CCM were in clinical stage
1, 4 in stage 2 and 3 in stage 3. Patients with TBM were started on anti tuberculous
therapy and all responded well to treatment. Two patients with CCM expired during
hospital stay while the rest responded well to amphotericin B and were discharged on
fluconazole.
Conclusion
It is not possible to differentiate TBM (seen in immunocompetent individuals) from
cryptococcal meningitis (seen predominantly in immunocompromised individuals) on
clinical grounds alone. Since CSF DR findings in the 2 conditions are similar, a high index
of suspicion is necessary for early diagnosis of cryptococcal meningitis, which is not a rare
infection. Cryptococcal antigen test and fungal cultures should be requested in all patients
with CSF findings of low glucose, high protein, and moderately high WBC and RBC
counts.
“ Focusing FIRST on PEOPLE “ 152 w w w . i s h e i d . c o m