Cerebral tuberculosis is the most severe type of extrapulmonary disease that is in developing countries highly predominant in children. Meningeal tuberculosis is the most common form and usually begins with respiratory infection followed by early haematogenous dissemination to extrapulmonary sites involving the brain. In comparison with the lung, Mycobacterium tuberculosis induces a very different immune response when infect the central nervous system. Herein, we review several aspects of the pathogenesis and immune response in pulmonary and cerebral tuberculosis in humans and experimental models and discuss the implications of this response in the cerebral infection outcome.
Tuberculosis ; Tuberculosis, Meningeal ; Cerebrospinal Fluid

No abstract available.
Adenosine Deaminase* ; Adenosine* ; Cerebrospinal Fluid* ; Child* ; Humans ; Tuberculosis, Meningeal*

OBJECTIVE: Most cases of syringomyelia with arachnoid scarring were related to spinal trauma or inflammatory reaction. The aim of this study is to analyze the influence of arachnoid scarring on the altered dynamics of cerebrospinal fluid(CSF) and determine the proper treatment. METHODS: Between Jan 1991 and Dec 2001, We have operated on 15 patients with progressive neurological deficits associated with syringomyelia. We analyze the clinical presentations, radiographic and magnetic resonance images. RESULTS: As to cause of syringomyelia, 11 patients were related with trauma and 4 patients were tuberculous meningitis. Shunting procedures underwent in 11 patients and 5 showed clinical improvement. Subarachnoid adhesiolysis and expansile duraplasty were performed in 4 patients and 3 experienced clinical improvement. The 6 patients with shunting procedures were neurologically deteriorated and 4 were reoperated. CONCLUSION: The arachnoid scarring interferes with CSF flow and causes syringomyelia. Successful long-term outcome in the surgical treatment of syringomyelia caused by focal arachnoid scar appeared to require microsurgical dissection of scar and expansile duroplasty. For extensive arachnoid scarring over multiple spinal levels or after previous surgery, shunting procedure may be indicated only.
Arachnoid* ; Arachnoiditis* ; Cerebrospinal Fluid ; Cicatrix ; Humans ; Syringomyelia* ; Tuberculosis, Meningeal

The variations of total cholesterol level of the cerebrospinal fluids were investigated in 28 cases of meningeal diseases in children(15cases of tuberculous meningitis and 13cases of purulent meningitis) and 10 cases of healthy children as control. 1. The cholesterol was not detectable in the cerebrospinal fluids of the healthy children. 2. On admission, the stage II of tuberculous meningitis showed slightly increased level of total cholesterol in cerebrospinal fluids(12.37.5mg%), whereas, Stage III of tuberculous meningitis showed markedly Increased level of total cholesterol in cerebrospinal fluids. (33.910.2mg%). 3. The purulent meningitis showed slightly increased Ievel of total cholesterol in cerebrospinal fluids(11.57.1mg%) on admission. 4. In 8 fatal cases of patients due to meningitis(5 cases of tuberculous meningitis and 3 cases of purulent meningitis), the reexamined total cholesterol level in cerebrospinal fluids have more increased than that admission. 5. On admission, the total cholesterol level of meningitis in cerebrospinal fluid was not correlation to other laboratory datas(total cholesterol level, cell count, sugar and protein levels in cerebrospinal fluid).
Cell Count ; Cerebrospinal Fluid* ; Child* ; Cholesterol* ; Humans ; Meningitis* ; Tuberculosis, Meningeal

For the pharmacokinetic analysis of isoniazid transfer into CSF, steady-state isoniazid concentrations of plasma and CSF were measured in eleven tuberculous meningitis patients confirmed with findings of CSF and neuroimazing. Peak plasma levels (4.17-21.5 micrograms/mL) were achieved at 0.25 to 3 hours after multiple isoniazid dose (600 mg/day). Terminal half-life, total clearance (CI/F) and volume of distribution (Vd/F) were 1.42 +/- 0.41 hr, 0.47 +/- 0.22 L/kg/hr and 0.93 +/- 0.48 L/kg, respectively. Isoniazid concentrations in CSF collected intermittently were highest at 3 hr (Mean, 4.18 micrograms/mL) and were 0.54 +/- 0.21 micrograms/mL at 12 hrs after the last dose of isoniazid 10 mg/kg/day. CSF/plasma partitioning of isoniazid and equilibration rate were estimated using modified pharmacokinetic/pharmacodynamic model. Disposition rate constant from CSF to plasma and CSF/plasma partitioning ratio of isoniazid were estimated to be 0.39 h-1 and 1.17, respectively.
Administration, Oral ; Humans ; Isoniazid/*cerebrospinal fluid ; Metabolic Clearance Rate ; Models, Biological ; Tuberculosis, Meningeal/*cerebrospinal fluid

No abstract available.
Cerebrospinal Fluid* ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay* ; Mycobacterium tuberculosis* ; Mycobacterium* ; Tuberculosis, Meningeal*

We report a case of decreased cerebrospinal fluid glucose with lymphocytic pleocytoisis in a patient with herpes zoster meningoencephalitis. The finding was likely to be confused with that of tuberculous meningoencephalitis. The concentration of CSF glucose is a critical point in the differential diagosis of various causes of nervous system infection. Although the herpes zoster meningoencephalitis isa well recognized, cases with markedly low, level of CSF glucose has been rare. We reviewed such unusual cases in the literature that were accompanied by hypoglycorrhachia. The duration of hypoglycorrhachia was transient. This suggests a differential point from that of tuberculous meningitis.
Cerebrospinal Fluid ; Encephalitis, Varicella Zoster* ; Glucose* ; Herpes Zoster* ; Humans ; Meningoencephalitis ; Nervous System ; Tuberculosis, Meningeal

By means of a sensitive radioirnrnunoassay method,ferritin was assessed in the cerebrospinal fluid (CSF) of 50 hospitalized subjects to evaluate its potential value for the diagnosis of tuberculous rneningititis. The rnean ferritin value obtained in the controls was 4.29ng /rnl with ranging between 1.7 and7.4ng/rmL The differences of CSF ferritin content between controls and patients with aseptic rneningitis as well as other non-infectious neurologic disorder were not significant. But rnarked elevation ranging 14 and 88ng/rnl (rnean, 37.4ng/rnl) were observed in patients with tuberculous rneningitis. And the ratio of CSF ferritin to serum ferritin in paients with tuberculous rneningitis was elevated significantly rnore than those in other groups inculuding controls, patients with aseptic rneningitis and other non-infectious neurologic disorder. The level in the serurn and CSF were independent, but that in CSF correlated vrith its total protein content. Results of this study suggest rneasuring CSF ferritin level are a valuable adjunct in differentiating aseptic meningitis from uncomplicated tuberculous meningitis.
Cerebrospinal Fluid ; Diagnosis ; Ferritins* ; Humans ; Meningitis* ; Meningitis, Aseptic ; Nervous System Diseases ; Tuberculosis, Meningeal

The aim of this study was to evaluate the diagnostic value of the cerebrospinal fluid (CSF) T-SPOT.TB test for the diagnosis of TB meningitis (TBM). A retrospective analysis of 96 patients with manifested meningitis was conducted; T-SPOT.TB test was performed for diagnosing TBM to determine the diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). A receiver operating characteristic (ROC) curve was also drawn to assess the diagnostic accuracy. The sensitivity, specificity, PPV, and NPV of CSF T-SPOT.TB test were 97.8%, 78.0%, 80.3%, and 97.5%, respectively, for 52 patients (54.2%) of the 96 enrolled patients. The area under the curve (AUC) was 0.910, and the sensitivities of CSF T-SPOT.TB for patients with stages I, II, and III of TBM were 96.7%, 97.2%, and 98.9%, respectively. CSF T-SPOT.TB test is a rapid and accurate diagnostic method with higher sensitivity and specificity for diagnosing TBM.
China ; epidemiology ; Humans ; Sensitivity and Specificity ; Tuberculosis, Meningeal ; cerebrospinal fluid ; diagnosis ; epidemiology

BACKGROUND: Rapid and accurate detection of Mycobacterium tuberculosis is important for patients with tuberculous meningitis because early diagnosis and prompt initiation of treatment improve the outcome of the disease. PCR techniques have been applied but are not yet well established for the diagnosis of tuberculous meningitis. The Amplicor(TM) M. tuberculosis test (Roche Diagnostic Systems, Inc. ) can be used fur the detection of M. tuberculosis by PCR technique, but its use has not been recommended currently for extrapulmonary samples. We evaluated the Amplicor(TM) M. tuberculosis test for the direct detection of M. tuberculosis from cerebrospinal fluid (CSF) specimens of patients suspicious of having tuberculous meningitis. METHODS: We examined a total of 103 CSF samples from 76 patients. Tuberculous meningitis was diagnosed by clinical history, chest X-ray, CSF chemistry, bacteriology, computed tomography and response to antituberculous treatment. Twenty-six samples were obtained from 13 patients with tuberculous meningitis. For the Amplicor(TM) M. tuberculosis test, 0.3 - 2.0 mL of CSF was centrifuged at 15,000 rpm for 15 min and its pellet was treated as the instructions of the kit. RESULTS: Of the 103 CSF samples, none were smear-positive by Ziehl-Neelsen acid-fast stain, seven were culture-positive and twelve were PCR-positive. Of the 26 samples from 13 patients with tuberculous meningitis, seven from six patients were culture-positive and eleven from six patients were PCR-positive. The sensitivity, specificity, positive and negative predictive values of the Amplicor(TM) M. tuberculosis test for the patients compared to the clinical diagnosis were 46.2, 98.4, 85.7, and 89.9%, respectively, while the culture yielded 46.2, 100.0, 100.0, and 90.0%, respectively. CONCLUSIONS: The Amplicor(TM) M. tuberculosis test using CSF specimen for the diagnosis of tuberculous meningitis is specific and is as sensitive as culture. The assay will provide rapid and valuable information for the diagnosis and control of tuberculous meningitis.
Bacteriology ; Cerebrospinal Fluid ; Chemistry ; Diagnosis* ; Early Diagnosis ; Humans ; Mycobacterium tuberculosis ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Thorax ; Tuberculosis* ; Tuberculosis, Meningeal*