Kamal Ahmed1, Md Mubin Uddin Akhanji2, Md Shahidul Islam3,
K.M. Ahasan Ahmed4, Md. Zakirul Islam5
1. Professor & Head of Department, Department of Neurology, North East Medical College & Hospital, Sylhet.
2. Associate Professor, Department of Psychiatry, M.A.G. Osmani Medical College & Hospital, Sylhet,
3. Junior Consultant, Department of Medicine, Government Employee Hospital, Fulbaria, Dhaka.
4. Junior Consultant, National Institute of Neurosciences & Hospital, Dhaka.
5. Assistant Professor, Department of Medicine, Kurmitola General Hospital, Dhaka.
Abstract
The Mycobacterium tuberculosis complex is the culprit behind the pandemic of tuberculosis (TB).It affects the health of around 10 million people annually, is among the top ten global killers, and is the second most common infectious killer after HIV. This study aimed to analyze the laboratory findings of Tuberculous meningitis patients in a tertiary care hospital in Bangladesh. This hospital-based prospective cross sectional study was carried out at the In-Patient Department of Clinical Neurology at the National Institute of Neurosciences & Hospital (NINS & H), Dhaka, Bangladesh from October 2016 to September 2017. Patients admitted to the hospital with features of Tuberculous Meningitis (TBM) were selected for the study. A consecutive sampling method was used to select a total of 54 patients following the inclusion and exclusion criteria. Informed written consent was obtained from each of the participant and ethical approval was also obtained from the ethical review committee of the study hospital. Data were collected through a pre-prepared questionnaire given to the participants and medical data were collected with a case record form. Among the study patients, the majority 38(70.4%) patients were aged >30. T28.2±12.3. The mean age of the patients were 28.2 ± 12.3 years. The majority patients were male 34(63.0%) and 20(37.0%) patients were female. Half of the patients (50%) had leukocytosis (WBC count > 11000 cu-mm) and over one-quarter (25.9%) exhibited raised ESR (> 50 mm). Over three-quarters (77.8%) had clear CSF fluid, followed by straw color in 9 (16.7%) patients, and hazy in 3 (5.6%). Gene X-pert were positive in 3 (5.6%) patients, and the median ADA value was 12.Baseline image findings revealed that 22(40.7%) cases had basal meningeal enhancement, 22(40.7%) hydrocephalus, 25(46.3%) infarction and 16(29.6%) Tuberculoma. Final diagnosis established 3(5.6%) cases as definite TBM, 30(55.6%) as probable and 21(38.9%) as possible TBM. This study concluded that, concerning laboratory findings, leukocytosis was present in half of the patients, over one-quarter exhibited raised ESR, and over three-quarters had clear CSF fluid followed by straw color. Gene X-pert was positive in 5.6% of patients.