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¸¾ì½¦¾−¡¾−Á²©ì¾¸ (2011), ¦½®ñ®êó 02: Îɾ 47 Œ 53¦ó¦÷²ñ− ¸ò©¾´¾ìó ²Éº´£½−½ ŒÎɾ 52patients with tuberculous meningitis. Int J TubercLung Dis 6: 64–70.Humphries MJ, Teoh R, Lau J, Gabriel M (1990). Factorsof prognostic significance in Chinese children withtuberculous meningitis. Tubercle 71: 161–8.Kalita J, Misra UK (1999). Outcome of tuberculousmeningitis at 6 and 12 months: a multiple regressionanalysis. Int J Tuberc Lung Dis 3: 261–5.Lincoln EM, Sordillo VR, Davies PA (1960). Tuberculousmeningitis in children. A review of 167 untreated and74 treated patients with special reference to earlydiagnosis. J Pediatr 57: 807–823.Misra UK, Kalita J, Srivastava M, Mandal SK (1996).Prognosis of tuberculous meningitis: a multivariateanalysis. J Neurol Sci 137: 57–61.Raviglione MC, Snider DE, Kochi A (1995). Globalepidemiology of tuberculosis. Morbidity and mortalityof a world wide epidemic. JAMA 273: 220–6.Snider DE and Roper WL (1992). The new tuberculosis. NEngl J Med 226: 703–5.Thwaites GE, Bang ND, Dung NH et al. (2004).Dexamethasone for the Treatment of TuberculousMeningitis in Adolescents and Adults. N Engl J Med351: 1741-51.Thwaites GE, Chau TTH and Farrar JJ (2004a). Improvingthe Bacteriological Diagnosis of TuberculousMeningitis. J Clin Microbiol 42: 378-9.Thwaites GE, Chau TTH, Stepniewska K, Phu NH,Chuong LV, Sinh DX, White NJ, Parry CM, Farrar JJ(2002). Diagnosis of adult tuberculous meningitis byuse of clinical and laboratory features. Lancet 360:1287-92.WHO (2007). Global tuberculosis control: key findings2008[http://www.who.int/tb/publications/global_report/2007/key_findings/en/index.html].WHO (2009). Global tuberculosis control. WHO Report2009.[http://www.who.int/tb/publications/global_report/2009/key_points/en/index.html]Wood M and Anderson M (1998). Chronic meningitis. In:Neurological infections; major problems in Neurology,vol 16. Philadelphia: WB Saunders, 1998; pp 169–248.TB Meningitis (TBM): An Important Problem Which Should Not be Neglected in Laos!Sisouphanh Vidhamaly 1 , Koukeo Phommasone 2* , Vilada Chansamouth 2, 4 , Simmaly Phongmany 2, 3 ,Valy Keoluangkhot 2, 3 , Rattanaphone Phetsouvanh 2, 4, 5 , Paul Newton 2, 5Received 18 April 2011; received in revised form 29 April 2011; accepted 29 April 2011.1. Tuberculosis Ward, Mahosot Hospital, Ministry of Health, Vientiane, Lao PDR2. Wellcome Trust – Mahosot Hospital – Oxford Tropical Medicine Research Collaboration, MahosotHospital, Vientiane, Lao PDR3. Infectious Disease Center, Mahosot Hospital, Vientiane, Lao PDR4. Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR5. Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine,University of Oxford, Churchill Hospital, Oxford, OX3 7LJ, UKAbstractTuberculosis (TB) is an infectious disease commonly found in both developing and developed countries.Tuberculosis meningitis (TBM) is a serious central nervous system infection with a high mortality rate despiteanti-TB drug treatment and is associated with HIV/AIDS. The diagnosis of TBM is difficult since the clinicalaspects of the disease are similar to other central nervous system infections, examination for AFB incerebrospinal fluid (CSF) stained with Ziehl-Neelsen is not sensitive and culture of Mycobacterium tuberculosisfrom CSF takes too long to influence initial therapy. Delayed diagnosis and treatment of TBM results in high

¸¾ì½¦¾−¡¾−Á²©ì¾¸ (2011), ¦½®ñ®êó 02: Îɾ 47 Œ 53¦ó¦÷²ñ− ¸ò©¾´¾ìó ²Éº´£½−½ ŒÎɾ 53mortality and disability. We report a Lao patient who had pulmonary TB in combination with TBM (confirmedby positive AFB in a sputum examination and a positive culture of Mycobacterium tuberculosis in the CSF)whose diagnosis and treatment were delayed resulting in serious nervous system sequelae and disability whichmay not be easily reversible. We discuss TBM diagnosis and use of simple clinical and laboratory features andsuggest a low threshold for empirical treatment with anti-TB drug in case of suspected TBM.Keywords: Tuberculosis, Meningitis, Delay, Diagnosis, Treatment Laos.*Corresponding author: Tel.: +856 20 55842842; fax: +856 21 242168; Email: koukeo@tropmedres.ac