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CSF Cytology and Bacteriophage Amplification in the Ealy Diagnosis of Tuberculous Meningit

Author: LiJingHong
Tutor: ZhangGuoJun；XuYuMing
School: Zhengzhou University
Course: Internal Medicine
Keywords: Cerebrospinal fluid Tuberculous meningitis Cytology Phage amplified biologically assay Diagnosis
CLC: R529.3
Type: Master's thesis
Year: 2009
Downloads: 33
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Abstract


Background and Purpose TB is infectious diseases pose a serious threat to human health and social stability. With the emergence of drug-resistant TB and AIDS epidemic and tuberculosis co-infection, tuberculosis worldwide one of the the humans most threatening infectious disease. According to WHO statistics, about 1/3 of the world's population is infected with Mycobacterium tuberculosis bacilli (MTB), an annual increase of 900 million and 300 million people died of the disease. Tuberculous meningitis (TBM referred tuberculous meningitis) is common violations of the central nervous system caused by the Mycobacterium tuberculosis infection and disease, tuberculous meningitis is a cure central nervous system infection at an early stage specificity The treatment is very effective, so the key to the prognosis is early diagnosis and timely treatment. Roche (LowensteinJensen) culture is the accepted standard for detection of Mycobacterium tuberculosis is an important basis to determine TB diagnosis and chemotherapy, but also a reliable assessment of efficacy, evaluate the therapeutic effect of standard. But the length of time required (1-2 months), and the positive rate of only 20-30%, is not conducive to clinical medicine. Conventional smear acid-fast staining, fast, cheap, but the positive rate is very low, can not distinguish between viable cells and dead bacteria. Nucleic acid amplification detection method is fast and accurate, but costly, demanding laboratory conditions. Therefore developed a fast and accurate detection of Mycobacterium tuberculosis clinical problems to be solved, the recent years, the rise of new phage amplified biologically assay (phageamplified biologically assay, PhaB) can quickly and accurately detect Mycobacterium tuberculosis, making TB rapid diagnosis and early treatment possible. The study by cerebrospinal fluid phage biological amplification detected Mycobacterium tuberculosis combined cerebrospinal fluid cytology dynamic observation, correlation analysis of the indicators. Trying to find a meaningful early diagnosis of tuberculous meningitis laboratory diagnostic methods, in order to provide the basis for the early diagnosis of tuberculous meningitis. Investigate the clinical value of the method in the diagnosis and treatment of tuberculous meningitis. Materials and Methods Case group (tuberculous meningitis group) for a total of 86 cases, 52 males and 34 females, aged 15-82 years old, with an average of 39.94 ± 11.19 years; control group 1 (central nervous system infection of non-tuberculous meningitis group) of 40 patients , 13 males and 27 females, aged 12-68 years old, with an average of 31.96 ± 18.03 years; 2 (control group) of the control group of 20 patients, 11 males and 9 females, age 9-57 years old, with an average of 26.44 ± 12.22 years old. Patients selected First Affiliated Hospital of Zhengzhou University, 2007-2008 Department of Respiratory Medicine, Department of Neurology, outpatient and inpatient, in all cases, according to history, clinical presentation and imaging, laboratory to confirm the diagnosis of tuberculous meningitis. All cases lumbar puncture and cerebrospinal fluid routine biochemistry, cytology, and ink, acid-fast staining and rapid culture of Mycobacterium tuberculosis. Results 1 knot brain cerebrospinal fluid white blood cell count in 80 cases (93.0%); protein increased in 76 cases (88.4%); chloride decreased in 50 cases (58.1%); sugar reduced by 52 cases (60.4%). Increased white blood cell count of the control group, 21 patients (52.5%); the sugar lowering 8 cases (20.0%); protein increased in 15 cases (37.5%); and chloride decreased 9 cases (22.5%). Increased white blood cell count of the control group, 2 cases (10.0%), other results were normal. Tuberculous meningitis group elevated white blood cell count and glucose showed a moderate decline, biochemical changes in the protein significantly increased and chloride decreased mainly CSF routine biochemical tests tuberculous meningitis diagnosis. 72 cases (83.7%); cerebrospinal fluid was mixed cell response in 8 cases (20%) of the control group, the control group of normal cytology triage patients with tuberculous meningitis easier cytology tuberculous meningitis cerebrospinal fluid was mixed cell reaction The mixed cell reaction. Phage amplified biologically assay detected 27 cases of Mycobacterium tuberculosis culture positive, the positive rate of 31.4%; 59 cases of tuberculous mycobacterial culture negative (68.6%). Control group 1 tuberculous mycobacterial culture was positive in five cases, the positive rate of 12.5%; 35 cases of Mycobacterium tuberculosis culture negative (87.5%), 2 Mycobacterium tuberculosis cultures were negative control group, there were significant differences in comparison with tuberculous meningitis group (P <0.05). Smear acid-fast staining was positive in only four cases (4.65%), negative in 82 cases (95.3%) were significantly different (P <0.05) compared with tuberculous meningitis. Incubated with the phage method can be observed within 18-24 hours a result, to shorten the Mycobacterium tuberculosis culture time. Conclusion the 1 knot brain group elevated white blood cell count and glucose showed a moderate decline, biochemical changes in the protein significantly increased and chloride decreased mainly cytology showed a mixed cell reaction. Phage amplified biologically assay Mycobacterium tuberculosis culture with traditional direct smear method compared to simple, rapid detection of Mycobacterium tuberculosis, takes 18-24 hours, and has a high sensitivity and specificity, good value for the diagnosis and treatment of tuberculous meningitis. 3 on the basis of the cerebrospinal fluid cytology joint phage amplified biologically assay rapid culture, the differential diagnosis of tuberculous meningitis and disease outcome judgment has high practical value. Provided the basis for the early diagnosis of tuberculous meningitis.

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CLC: > Medicine, health > Internal Medicine > TB > Cerebral tuberculosis and tuberculous meningitis
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