PDF(Pubmed)
Abstract：
UNASSIGNED: Tuberculous meningitis (TBM) is a severe form of tuberculosis affecting the meninges, primarily caused by Mycobacterium tuberculosis. Diagnosis of TBM poses numerous challenges due to its nonspecific clinical presentation and the limitations of diagnostic tests like GeneXpert.
UNASSIGNED: The authors report a case of a 22-year-old female from Eastern Nepal presenting with acute-onset fever, headache, vomiting, and neck pain. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis, elevated protein, low glucose levels, and cobweb coagulum indicative of TBM. However, the GeneXpert test revealed negative results.
UNASSIGNED: In resource-limited settings like Nepal, where access to GeneXpert MTB/Rif is limited, CSF analysis and clinical algorithms play a crucial role in diagnosing TBM. Relying solely on GeneXpert results may lead to false negatives, so a high level of suspicion based on patient risk factors is essential. Prompt initiation of empirical antitubercular therapy is vital for a favorable outcome in TBM cases.
UNASSIGNED: Negative MTB PCR results from CSF can be misleading in diagnosis of tubercular meningitis. Therefore, comprehensive evaluations, including detailed patient history, physical examination, and CSF fluid analysis, are crucial in high tuberculous prevalence countries to ensure accurate and timely diagnosis.
UNASSIGNED: The authors report a case of a 22-year-old female from Eastern Nepal presenting with acute-onset fever, headache, vomiting, and neck pain. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis, elevated protein, low glucose levels, and cobweb coagulum indicative of TBM. However, the GeneXpert test revealed negative results.
UNASSIGNED: In resource-limited settings like Nepal, where access to GeneXpert MTB/Rif is limited, CSF analysis and clinical algorithms play a crucial role in diagnosing TBM. Relying solely on GeneXpert results may lead to false negatives, so a high level of suspicion based on patient risk factors is essential. Prompt initiation of empirical antitubercular therapy is vital for a favorable outcome in TBM cases.
UNASSIGNED: Negative MTB PCR results from CSF can be misleading in diagnosis of tubercular meningitis. Therefore, comprehensive evaluations, including detailed patient history, physical examination, and CSF fluid analysis, are crucial in high tuberculous prevalence countries to ensure accurate and timely diagnosis.
摘要：
■结核性脑膜炎（TBM）是一种影响脑膜的严重结核病，主要由结核分枝杆菌引起。由于其非特异性临床表现和GeneXpert等诊断测试的局限性，TBM的诊断提出了许多挑战。
作者报告了一例来自尼泊尔东部的22岁女性，出现急性发热，头痛,呕吐,颈部疼痛。脑脊液（CSF）分析显示淋巴细胞增多，蛋白质升高，低葡萄糖水平，和指示TBM的蛛网凝结物。然而,GeneXpert测试显示阴性结果.
■在尼泊尔等资源有限的环境中，对GeneXpertMTB/Rif的访问受到限制，CSF分析和临床算法在诊断TBM中起着至关重要的作用。仅仅依靠GeneXpert的结果可能会导致假阴性，因此，基于患者风险因素的高度怀疑是必不可少的。及时开始经验性抗结核治疗对于TBM病例的良好预后至关重要。
■来自CSF的MTBPCR阴性结果可能会误导结核性脑膜炎的诊断。因此,综合评价,包括详细的病史,体检,和脑脊液分析，在高结核病流行率国家是至关重要的，以确保准确和及时的诊断。
作者报告了一例来自尼泊尔东部的22岁女性，出现急性发热，头痛,呕吐,颈部疼痛。脑脊液（CSF）分析显示淋巴细胞增多，蛋白质升高，低葡萄糖水平，和指示TBM的蛛网凝结物。然而,GeneXpert测试显示阴性结果.
■在尼泊尔等资源有限的环境中，对GeneXpertMTB/Rif的访问受到限制，CSF分析和临床算法在诊断TBM中起着至关重要的作用。仅仅依靠GeneXpert的结果可能会导致假阴性，因此，基于患者风险因素的高度怀疑是必不可少的。及时开始经验性抗结核治疗对于TBM病例的良好预后至关重要。
■来自CSF的MTBPCR阴性结果可能会误导结核性脑膜炎的诊断。因此,综合评价,包括详细的病史,体检,和脑脊液分析，在高结核病流行率国家是至关重要的，以确保准确和及时的诊断。
