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Volume 14, Number 9—September 2008

Dispatch

Diagnostic Challenges of Central Nervous System Tuberculosis

Laura J. ChristieComments to Author , Ann M. Loeffler, Somayeh Honarmand, Jennifer M. Flood, Roger Baxter, Susan Jacobson, Rick Alexander, and Carol A. Glaser
Author affiliations: California Department of Public Health, Richmond, California, USA (L.J. Christie, S. Honarmand, J.M. Flood, C.A. Glaser); Children’s Hospital and Research Center at Oakland, Oakland, California, USA (L.J. Christie); Legacy Emanuel Children’s Hospital, Portland, Oregon, USA (A.M. Loeffler); Francis J. Curry National Tuberculosis Center, San Francisco, California, USA (A.M. Loeffler); Kaiser Oakland Medical Center, Oakland (L.J. Christie, R. Baxter); Kaiser Fremont Medical Center, Fremont, California, USA (S. Jacobson); Contra Costa County Public Health Laboratory, Martinez, California, USA (R. Alexander);

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Table

Comparison of TB encephalitis with viral encephalitis, California Encephalitis Project*

Characteristic CNS TB HSV-1 Enterovirus
Total no. cases
20
39
44
Patient demographics
Male, no. (%) 12 (60) 14 (36) 25 (57)
Median age, y (range) 41 (8 mo–77y) 55 (8 mo–89 y) 13 (6 mo–74 y)†
Race white, non-Hispanic, no. (%)
3 (15)
22 (69)‡
14 (33)
Clinical data
Interval from CNS onset to admission, d, median (range) 5 (0–62) 2 (0–28) 2 (0–18)†
ICU care, no (%) 15 (75) 19 (56) 20 (53)
Fever, no. (%) 15 (75) 35 (92) 35 (80)
Seizures, no. (%) 7 (35) 22 (58) 12 (27)
Altered consciousness, no. (%) 13 (65) 30 (79) 20 (50)
Personality change, no. (%) 9 (45) 17 (45) 7 (17)†
Hallucinations, no. (%) 3 (16) 7 (21) 3 (7)
Stiff neck, no. (%) 14 (70) 12 (32)§ 19 (44)
Ataxia, no. (%) 7 (37) 6 (23) 11 (28)
Length of hospital stay, d, median (range)
30 (8–753)
15 (0–738)§
6 (0–1,124)¶
Laboratory results
CSF leukocytes, per mL, median (range) 201 (42–2,845) 47 (0–975)‡ 85 (0–1,080)†
CSF protein, mg/dL, median (range) 174 (66–357) 71 (15–297)‡ 60 (19–881)¶
CSF glucose, mg/dL, median (range)
35 (9–132)
69 (39–112)‡
67 (38–159)¶
MRI/CT (abnormal, initial study), no. (%)
17 (85)
36 (95)
12 (39)¶
Inpatient deaths, no. (%) 6 (30) 8 (21) 4 (9)†

*CNS, central nervous system; TB, tuberculosis (Mycobacterium tuberculosis); HSV-1, herpes simplex virus 1; ICU, intensive care unit; CSF, cerebrospinal fluid; MRI, magnetic resonance imaging; CT, computed tomography. Denominators may vary slightly depending on available data. Data were analyzed (2-way analysis) by using Fisher exact test, χ2 test, or Kruskal-Wallis test as appropriate, with statistical significance set at α = 0.05. Comparisons without a symbol did not reach statistical significance.
†CNS TB vs. enterovirus, p<0.05.
‡CNS TB vs. HSV-1, p<0.001.
§CNS TB vs. HSV-1, p<0.05.
¶CNS TB vs. enterovirus, p<0.001.

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