Analysis on misdiagnosis of tuberculous meningitis in the elderly
10.3760/cma.j.issn.0254-9026.2017.07.011
- VernacularTitle:老年人结核性脑膜炎误诊分析
- Author:
Mailing HUANG
;
Yan MA
;
Mengqiu GAO
;
Yanhua SONG
;
Hongmei CHEN
;
Zhongshun KONG
;
Liqun ZHANG
;
Liping PAN
;
Xiaoyou CHEN
;
Qi LI
- Keywords:
Tuberculosis,meningeal;
Diagnostic errors
- From:
Chinese Journal of Geriatrics
2017;36(7):759-764
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the clinical characteristics of elderly patients with tuberculous meningitis (TBM) and analyze the causes of misdiagnosis.Methods The clinical data of patients aged 60 years and over with TBM in Beijing Chest Hospital Affiliated to Capital Medical University from January 2011 to January 2017 were retrospectively analyzed.The clinical characteristics of the elderly patients with TBM were analyzed and compared between misdiagnosis and non-misdiagnosis groups.Results Among 60 elderly patients with TBM,32 cases (53.3%) were misdiagnosed before hospitalization.Among 32 misdiagnosed cases,11 (34.4%) were misdiagnosed as pulmonary infection,6 (18.8%) as infectious diseases with unspecified site,4(12.5%) as upper respiratory tract infections and 3 (9.4%) as cerebral vascular diseases,and so on.The onset time of TBM,fever prevalence and CSF glucose levels were 42.5 (20.3,60.0) d,96.9% (31 cases),1.5(1.1,2.3)mmol/L in misdiagnosis group respectively,and 15.0 (10.0,20.0) d,75.0%(21 cases),2.3(1.4,3.2)mmol/L in non-misdiagnosis group respectively,which was statistically significantly different between the two groups (all P< 0.05).There were no statistically significant differences in age,gender,occupation,residence,complications,comorbidities,radiographic signs between the two groups (all P> 0.05).Conclusions Elderly patients with TBM have atypical clinical manifestations,many comorbidities,and less specific imaging,and especially,the cerebrospinal fluid pathogen sensitivity is low,which may result in higher misdiagnosis rate.
