Tuberculous and cryptococcal meningitis in a setting with high TB and low HIV prevalence.
OBJECTIVE
To compare the differences in presentation and outcome of patients with tuberculous meningitis (TBM) and cryptococcal meningitis (CCM).


METHODS
Case series.


METHODS
The Aga Khan University Hospital, Karachi, from December 1995 to December 2005.


METHODS
Patients with a confirmed diagnosis of TBM or CCM were included in this study. The signs and symptoms, laboratory findings and other variables of patients were entered and analyzed by Statistical Package for Social Sciences (SPSS) Software version 14.


RESULTS
We compared 16 patients of TBM with 11 of CCM. None of the patients with TBM were Human Immunodeficiency Virus (HIV) positive while 4 patients with CCM had HIV. The common initial signs and symptoms in patients with TBM were fever, altered mental status and headache; and in patients with CCM were fever, headache and cough. The mean CSF glucose level decreased according to the Medical Research Council (MRC) stage in TBM. The mean CSF RBCs, WBCs, glucose and protein in TBM were 2010/mm3, 228/mm3, 52.32 mg/dL and 289.48 mg/dl respectively and in CCM were 178.54/mm3, 529.54/mm3, 32.63 mg/dL and 432.18 mg/dL respectively.


CONCLUSIONS
TBM and CCM should be suspected in all cases that present with symptoms of chronic meningitis. Patients with TBM are more likely to have altered mental status and higher CSF RBCs; those with CCM are more likely to have headache, cough and higher CSF WBCs.
Khan
Afrasyab
A
Department of Surgery, The Aga Khan University Hospital, Karachi. afrasyabkhan@gmail.com
Jamil
Bushra
B
Ali
Rahmat
R
Sultan
Sana
S
D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers; D002555:Cerebrospinal Fluid; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D014390:Tuberculosis, Meningeal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D004234:Diuretics, Osmotic; D008353:Mannitol; D000666:Amphotericin B